| Thriveworks Clinical - Colorado Pc | |
|
4155 Darley Ave Ste F-1 Boulder CO 80305-6536 | |
| (855) 284-7483 | |
| (617) 807-0958 |
| Full Name | Thriveworks Clinical - Colorado Pc |
|---|---|
| Speciality | Counselor |
| Location | 4155 Darley Ave Ste F-1, Boulder, Colorado |
| Authorized Official Name and Position | Anthony Centore (CEO) |
| Authorized Official Contact | 5402176461 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Thriveworks Clinical - Colorado Pc Po Box 748465 Atlanta GA 30374-8465 Ph: (855) 284-7483 | Thriveworks Clinical - Colorado Pc 4155 Darley Ave Ste F-1 Boulder CO 80305-6536 Ph: (855) 284-7483 |
| NPI Number | 1891462024 |
|---|---|
| Provider Enumeration Date | 08/25/2021 |
| Last Update Date | 02/11/2025 |
| Certification Date | 02/11/2025 |
| Medicare PECOS PAC ID | 8820487671 |
|---|---|
| Medicare Enrollment ID | O20211116002126 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891462024 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Scott Gordon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1821038159 PECOS PAC ID: 5799715413 Enrollment ID: I20220628000949 |
| Provider Name | Shaheen Emmanuel Lakhan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649585944 PECOS PAC ID: 4082937255 Enrollment ID: I20230516003698 |
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