| Fountainhead Psychology Group, Llc | |
|
1828 N Clarkson St Denver CO 80218-1030 | |
| (303) 818-5540 | |
| Not Available |
| Full Name | Fountainhead Psychology Group, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1828 N Clarkson St, Denver, Colorado |
| Authorized Official Name and Position | Amy B. Crockett (PRESIDENT) |
| Authorized Official Contact | 3038185540 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fountainhead Psychology Group, Llc 641 York St Denver CO 80206-3745 Ph: (303) 818-5540 | Fountainhead Psychology Group, Llc 1828 N Clarkson St Denver CO 80218-1030 Ph: (303) 818-5540 |
| NPI Number | 1043605009 |
|---|---|
| Provider Enumeration Date | 04/06/2015 |
| Last Update Date | 04/27/2021 |
| Certification Date | 04/07/2021 |
| Medicare PECOS PAC ID | 2466755699 |
|---|---|
| Medicare Enrollment ID | O20160122000325 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043605009 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 2526 (Colorado) | Primary |
| Provider Name | Amy Baldwin Crockett |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1265431407 PECOS PAC ID: 7719946367 Enrollment ID: I20041008000131 |
| Provider Name | Hannah Benedetti |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1124441233 PECOS PAC ID: 6800228909 Enrollment ID: I20191111002469 |
| Provider Name | Julian T. Frazier |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1073035945 PECOS PAC ID: 7012305865 Enrollment ID: I20211027001450 |
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