Organization
TEN MILE HEALTH & WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THERESA LARKIN CLARK MD (PRESIDENT)
(970) 455-9004
Entity
Organization
Contact information
Practice address
114 VILLAGE PLACE, ST 207, DILLON, CO 80435
(970) 455-9004
(949) 577-4247
Mailing address
PO BOX 2098, DILLON, CO 80435-2098
(970) 455-9004
(949) 577-4247
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000169353
—
CO
Enumeration date
04/14/2021
Last updated
04/14/2021
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