FOUR CORNERS MENTAL HEALTH, LLC (NPI# 1528169117) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528169117 |
| Entity Type | Organization |
| Organization Name | FOUR CORNERS MENTAL HEALTH, LLC |
| Practice Address |
2855 Main Ave Suite A105 Durango CO 81301 |
| Practice Telephone | 9703826690 |
| Practice Fax Number | 9703820207 |
| Mailing Telephone | 9703826690 |
| Mailing Fax Number | 9703820207 |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2011-06-22 |
| Authorized Official Name | MARK A BRAUNSTEIN (OWNER) |
| Authorized Official Telephone | 9703826690 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
40471 | CO | Behavioral Health & Social Service Providers |
| Y | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
Behavioral Health & Social Service Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Four Corners Mental Health, LLC | 2855 Main Avenue, Suite 105a, Durango, CO 81301 |
| Street Address |
2855 MAIN AVE SUITE A105 |
| City | DURANGO |
| State | CO |
| Zip Code | 81301 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740397587 | Regan S Thaw | Social Worker | 2855 Main Ave, Suite A105, Durango, CO 81301-5956 | 2006-08-25 |
| 1255737581 | Mark Dickmann, Msw, Lcsw, LLC | Social Worker | 2855 Main Ave, Suite A-107, Durango, CO 81301-5956 | 2014-11-13 |
| 1639517766 | Envision Durango LLC | Optometrist | 2855 Main Ave, Ste A103, Durango, CO 81301-5956 | 2013-06-11 |
| 1568766319 | Peak Wellness and Nutrition Inc. | Clinic/Center | 2855 Main Ave, Ste. 105a, Durango, CO 81301-5956 | 2011-01-07 |
| 1477702835 | Matthew Evan Burgess | Optometrist | 2855 Main Ave, Ste A103, Durango, CO 81301-5956 | 2008-09-10 |
| 1164620886 | Mark Rm Dickmann | Social Worker | 2855 Main Ave, Suite A-107, Durango, CO 81301-5956 | 2007-07-03 |
| 1336283761 | Ruby Jo Walker | Social Worker | 2855 Main Ave, Unit A107, Durango, CO 81301-5956 | 2007-02-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467003541 | High Country Counseling, LLC | Social Worker | 101 East 31st Street, Unit B, Durango, CO 81301 | 2019-09-20 |
| 1033629431 | Southern Rockies Addiction Treatment Services | Substance Abuse Rehabilitation Facility | 736 Goeglein Gulch, Durango, CO 81301 | 2017-10-11 |
| 1649710583 | Dr. Michael Washinsky, LLC | Psychiatry & Neurology | 1800 East 3rd Ave., Suite 102, Durango, CO 81301 | 2017-02-25 |
| 1578000113 | Taylor Ferraro | Prevention Professional | 221 E 4th Ave Unit B, Durango, CO 81301 | 2017-01-20 |
| 1467811224 | Newelldixon, Pllc | Clinic/Center | 29423 E. Highway 160, Durango, CO 81301 | 2016-02-22 |
| 1699146803 | Leah Linder | Naturopath | 117 Cr 250. Suite A, Durango, CO 81301 | 2015-10-14 |
| 1780065136 | Jeffrey Hines | Occupational Therapy Assistant | 970 Silver Mesa Driveway, Durango, CO 81301 | 2015-06-11 |
| 1467832410 | Sara Supinski LLC | Clinic/Center | 1911 Main Ave, Suite 240, Durango, CO 81301 | 2015-06-04 |
| 1356735146 | Margaret Austin | Massage Therapist | 1309 E 3rd Avenue, Durango, CO 81301 | 2015-03-19 |
| 1891112280 | Lisa Ann Proulx | Health Educator | 3 Springs Blvd.. Suite 201, Durango, CO 81301 | 2014-03-24 |
| Find all providers in zip 81301 | ||||
| Taxonomy Code | 103TC2200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical Child & Adolescent |
| Definition to come... |
| Notes: [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174099857 | I Have A Dream Foundation - Colorado | Psychologist | Strive Prep - Ruby Hill, 2626 W. Evans Ave, Denver, CO 80219 | 2018-10-19 |
| 1699217778 | Bradley Kent Jackson | Psychologist | 13123 E 16th Ave # 245, Aurora, CO 80045-7106 | 2016-11-07 |
| 1447614383 | Lauren Shomaker | Psychologist | 410 Pitkin St, 1570 Campus Delivery, Fort Collins, CO 80523-1570 | 2016-04-06 |
| 1811301153 | Rachel Ahern | Psychologist | 1298 Peoria St, Aurora, CO 80011-6206 | 2014-06-15 |
| 1942610258 | Stephanie Miller | Psychologist | 150 W 9th Ave Unit 2115, Denver, CO 80204-4045 | 2014-05-08 |
| 1346650454 | Maribel Hinojosa Psyd LLC | Psychologist | 7200 E Dry Creek Rd Ste G208, Centennial, CO 80112-2575 | 2014-04-29 |
| 1427315613 | Lisa Ann Mcclun | Psychologist | 447 W Columbia Ave, Telluride, CO 81435-9448 | 2012-04-12 |
| 1891063582 | Marcia L Braden | Psychologist | 214 E Dale St, #110, Colorado Springs, CO 80903-4729 | 2011-12-08 |
| 1245523430 | Marcela Torres | Psychologist | 1440 15th Street, Boulder, CO 80309-7106 | 2011-05-19 |
| 1306150727 | Nancy Gary | Psychologist | 5290 E Yale Cir Ste 207, Denver, CO 80222-6933 | 2010-07-27 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.