Provider Demographics
NPI:1891502753
Name:MAJESTIC MOUNTAIN MENTAL HEALTH LLC
Entity type:Organization
Organization Name:MAJESTIC MOUNTAIN MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APN, PMHNP-BC
Authorized Official - Phone:719-212-1928
Mailing Address - Street 1:1580 N LOGAN ST
Mailing Address - Street 2:STE 660 #281714
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203
Mailing Address - Country:US
Mailing Address - Phone:719-212-1928
Mailing Address - Fax:719-888-1866
Practice Address - Street 1:405 W BOWMAN AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-5010
Practice Address - Country:US
Practice Address - Phone:719-212-1928
Practice Address - Fax:719-888-1866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-14
Last Update Date:2024-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty