# CIRQUE MEADOW PSYCHIATRY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Cirque Meadow Psychiatry Virginia Caryl Mack Sole MBR
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578184230
- **Authorized official:** VIRGINIA MACK APRN (OWNER)
- **Authorized official phone:** (360) 621-1409

## Contact information

- **Practice address:** CIRQUE MEADOW PSYCHIATRY, 211 WEST MYRTE STREET, SUITE 207, FORT COLLINS, CO 80521-2971
- **Practice address phone:** (360) 621-1409
- **Practice address fax:** (848) 213-0217
- **Mailing address:** 415 S WASHINGTON AVE, FORT COLLINS, CO 80521-2571
- **Mailing address phone:** (360) 621-1409
- **Mailing address fax:** (848) 213-0217

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |
| 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