| Mile High Psychiatry Llc | |
|
2450 Saint Rose Pkwy Ste 120 Henderson NV 89074-7770 | |
| (480) 847-2998 | |
| (720) 367-5067 |
| Full Name | Mile High Psychiatry Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 2450 Saint Rose Pkwy Ste 120, Henderson, Nevada |
| Authorized Official Name and Position | Michael K Chism (OWNER) |
| Authorized Official Contact | 3035878592 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mile High Psychiatry Llc 3753 Howard Hughes Pkwy Ste 200 Las Vegas NV 89169-0952 Ph: (480) 847-2998 | Mile High Psychiatry Llc 2450 Saint Rose Pkwy Ste 120 Henderson NV 89074-7770 Ph: (480) 847-2998 |
| NPI Number | 1790405348 |
|---|---|
| Provider Enumeration Date | 09/01/2022 |
| Last Update Date | 11/09/2022 |
| Certification Date | 11/09/2022 |
| Medicare PECOS PAC ID | 9133587900 |
|---|---|
| Medicare Enrollment ID | O20230627000668 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790405348 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
| Provider Name | Julie B Cruse |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891196135 PECOS PAC ID: 1557684123 Enrollment ID: I20221107001017 |
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