Provider Demographics
NPI:1396143616
Name:PSYCHED-IN
Entity type:Organization
Organization Name:PSYCHED-IN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:ANDERSON FAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:303-380-1858
Mailing Address - Street 1:2055 S ONEIDA ST
Mailing Address - Street 2:SUITE 290
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-2434
Mailing Address - Country:US
Mailing Address - Phone:303-380-1858
Mailing Address - Fax:303-639-3244
Practice Address - Street 1:2055 S ONEIDA ST
Practice Address - Street 2:SUITE 290
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-2434
Practice Address - Country:US
Practice Address - Phone:303-380-1858
Practice Address - Fax:303-639-3244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1686101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty