Organization
JEFFERSON CENTER FOR MENTAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID A GOFF (CHIEF FINANCIAL OFFICER)
(303) 432-5164
Entity
Organization
Contact information
Practice address
31207 KEATS WAY STE 202, EVERGREEN, CO 80439-2220
(303) 432-5300
(303) 432-5350
Mailing address
4851 INDEPENDENCE ST STE 200, WHEAT RIDGE, CO 80033-6712
(303) 425-0300
(303) 432-5071
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
150413
CO
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000163981
—
CO
Enumeration date
02/02/2011
Last updated
12/04/2020
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