Organization
EMERGENCE PSYCHEDELIC THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACY GREEN MD (OWNER)
(720) 442-3565
Entity
Organization
Contact information
Practice address
825 S BROADWAY ST STE 100, BOULDER, CO 80305-5932
(303) 578-8845
Mailing address
825 S BROADWAY ST STE 100, BOULDER, CO 80305-5932
(303) 578-8845
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
10/22/2025
Last updated
01/23/2026
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