| Southeast Mental Health Services | |
|
711 Barnes Ave La Junta CO 81050-2138 | |
| (719) 384-5446 | |
| (719) 384-5672 |
| Full Name | Southeast Mental Health Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 711 Barnes Ave, La Junta, Colorado |
| Authorized Official Name and Position | Lisa Chavez (CONTRACT & CREDENTIALING MANAGER) |
| Authorized Official Contact | 7193835448 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeast Mental Health Services 711 Barnes Ave La Junta CO 81050-2138 Ph: (719) 384-5446 | Southeast Mental Health Services 711 Barnes Ave La Junta CO 81050-2138 Ph: (719) 384-5446 |
| NPI Number | 1417945254 |
|---|---|
| Provider Enumeration Date | 10/06/2005 |
| Last Update Date | 09/13/2022 |
| Certification Date | 09/13/2022 |
| Medicare PECOS PAC ID | 3072552678 |
|---|---|
| Medicare Enrollment ID | O20050502001348 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417945254 | NPI | - | NPPES |
| 4034013 | Other | CO | MEDICAID CAPITATION PROGR |
| 4160099 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 0426 (Colorado) | Primary |
| Provider Name | Ergi O Gumusaneli |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225283260 PECOS PAC ID: 7315186251 Enrollment ID: I20130625000536 |
| Provider Name | Danya K Herrell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467702027 PECOS PAC ID: 1951735612 Enrollment ID: I20200106001386 |
| Provider Name | Troy Riutta |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396237640 PECOS PAC ID: 9032465869 Enrollment ID: I20221108000644 |
| Provider Name | Cheyenne E Kuhn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285128413 PECOS PAC ID: 3476921727 Enrollment ID: I20221118000613 |
Southeast Mental Health Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 613 Barnes Ave, La Junta, CO 81050 Phone: 719-384-5446 Fax: 719-384-5672 | |
Ark Valley Counseling & Supervision Services, Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 24600 County Road 21, La Junta, CO 81050 Phone: 719-469-2670 | |
Ark Valley Counseling & Supervision Services, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 317 W 3rd St Ste 203, La Junta, CO 81050 Phone: 719-469-2670 | |
Divine Health Group Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 1206 E 3rd St, La Junta, CO 81050 Phone: 719-413-5261 | |
Valley Community Counseling Services, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 313 W 3rd Street Lincoln Square Professional Building, Suite 204, La Junta, CO 81050 Phone: 719-469-0799 | |
Single Point Services Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 302 Barnes Ave, La Junta, CO 81050 Phone: 719-384-8503 Fax: 719-384-8411 | |
Valley-wide Health System, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 721 Barnes Ave, La Junta, CO 81050 Phone: 719-384-5446 |