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Organization
CIRQUE MEADOW PSYCHIATRY
Active
Organization
CIRQUE MEADOW PSYCHIATRY
Active
Other names
Cirque Meadow Psychiatry Virginia Caryl Mack Sole MBR
Organization subpart
No
Provider details
NPI number
Authorized official
VIRGINIA MACK APRN (OWNER)
(360) 621-1409
Entity
Organization
Contact information
Practice address
CIRQUE MEADOW PSYCHIATRY, 211 WEST MYRTE STREET, SUITE 207, FORT COLLINS, CO 80521-2971
(360) 621-1409
(848) 213-0217
Mailing address
415 S WASHINGTON AVE, FORT COLLINS, CO 80521-2571
(360) 621-1409
(848) 213-0217
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
364SP0807X
Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
—
NULL
364SP0807X
Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
—
—
Other
Enumeration date
05/04/2020
Last updated
07/29/2020
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