| Willow Grove Mental Health, Inc. | |
|
14211 E 4th Ave Aurora CO 80011-8736 | |
| (720) 262-9100 | |
| (720) 262-9101 |
| Full Name | Willow Grove Mental Health, Inc. |
|---|---|
| Speciality | Nurse Practitioner - Psychiatric/mental Health |
| Location | 14211 E 4th Ave, Aurora, Colorado |
| Authorized Official Name and Position | Mary Elizabeth Waggoner (PRESIDENT) |
| Authorized Official Contact | 7202629100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Willow Grove Mental Health, Inc. 14211 E 4th Ave # 3-138 Aurora CO 80011-8736 Ph: (720) 262-9100 | Willow Grove Mental Health, Inc. 14211 E 4th Ave Aurora CO 80011-8736 Ph: (720) 262-9100 |
| NPI Number | 1023502549 |
|---|---|
| Provider Enumeration Date | 06/18/2018 |
| Last Update Date | 10/30/2020 |
| Certification Date | 10/30/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023502549 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 09923992 (Colorado) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | 0770900 (Colorado) | Primary |
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