Provider Demographics
NPI:1386476968
Name:LAVENDER MENTAL HEALTH LLC
Entity type:Organization
Organization Name:LAVENDER MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROPHY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:970-426-0636
Mailing Address - Street 1:835 E 2ND AVE STE 271
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5488
Mailing Address - Country:US
Mailing Address - Phone:970-426-0636
Mailing Address - Fax:
Practice Address - Street 1:835 E 2ND AVE STE 271
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5488
Practice Address - Country:US
Practice Address - Phone:970-426-0636
Practice Address - Fax:970-844-1722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-14
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1558905489OtherNPI FOR INDIVIDUAL