CIRQUE MEADOW PSYCHIATRY NPI 1578184230

NPI Information

NPI: 1578184230
Provider Name: CIRQUE MEADOW PSYCHIATRY

Other Name: CIRQUE MEADOW PSYCHIATRY VIRGINIA CARYL MACK SOLE MBR

Classification: Nurse Practitioner - 363LP0808X
Entity Type: Organization

Specialization: Psychiatric/Mental Health

Address:
CIRQUE MEADOW PSYCHIATRY
211 WEST MYRTE STREET, SUITE 207
FORT COLLINS, CO
ZIP 80521
Phone: (360) 621-1409
Get Directions

CIRQUE MEADOW PSYCHIATRY is a psychiatric/mental health nurse practitioner in Fort Collins, CO. CIRQUE MEADOW PSYCHIATRY NPI is 1578184230. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Other Name Is Cirque Meadow Psychiatry Virginia Caryl Mack Sole Mbr.

The provider's business location address is:

CIRQUE MEADOW PSYCHIATRY
211 WEST MYRTE STREET, SUITE 207
FORT COLLINS, CO
ZIP 80521-971
Phone: (360) 621-1409
Fax: (848) 213-0217

The provider's authorized official is Virginia Mack .
The authorized official title is Owner and has the following contact phone number (360) 621-1409.

The enumeration date for this NPI number is 5/4/2020 and was last updated on 7/29/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health			Yes
2	364SP0807X	Clinical Nurse Specialist	Psychiatric/Mental Health, Child & Adolescent			No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	APN0990068-NP	OTHER	COLORADO	MEDICAL LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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