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
—
—
364SP0807X
Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
APN0990068-NP
MEDICAL LICENSE
CO
Enumeration date
05/04/2020
Last updated
07/29/2020
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