Organization
POUDRE VALLEY MEDICAL GROUP, LLC
Active
Other names
UCHealth Medical Group, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JANA CONROY (CREDENTIALING MANAGER)
(970) 624-4443
Entity
Organization
Contact information
Practice address
1400 E BOULDER ST STE 1200, COLORADO SPRINGS, CO 80909-5533
(719) 365-7905
Mailing address
2695 ROCKY MOUNTAIN AVE STE 150, LOVELAND, CO 80538-9071
(719) 365-7905
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
07/06/2021
Last updated
07/06/2021
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