The 40 20 Collective LLC
Organization Active NPI Psychiatric/Mental Health Nurse Practitioner · Lakewood, CO
NPI 1154050128 · NPPES record last updated Jun 30, 2022
Key facts
- NPI
- 1154050128
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- Legal business name
- THE 40 20 COLLECTIVE LLC
- Practice address
- 14143 Denver West Pkwy Ste 100
Lakewood, CO 80401-3275 - Phone
- (720) 594-5556
- NPI assigned
- Jun 6, 2022
- Organization subpart
- No
Authorized official
- Name
- Meghan Dow, DNP
- Title
- Owner
- Phone
- (720) 594-5556
Practitioners 12
-
Meghan Lee Dow, DNP-PMHNP
-
Heather S Ford, NP
-
Kelly Lowther, LCSW
-
Margaret Lynn Decosta, PMHNP
-
Erin Boerio, LPC
-
Jessica Lyon, LCSW
-
James Huff Niforatos, MSN, APN, PMHNP-BC
-
Aimee R. Techau, PMHNP-BC
-
Valerie Dawn Newsum, LPC, NCC, MA
-
Melissa Shulman, PMHNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220707003780 | CO | Part B Supplier - Clinic/Group Practice | 1557741527 |
Receives reassigned benefits from 10 practitioners Practice locations: Lakewood, CO |
National Provider Directory
Interoperability endpoints
- https://api.platform.athenahealth.com/26636/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner |
363LP0808X | Yes |
Addresses
Primary practice location
14143 Denver West Pkwy Ste 100
Lakewood, CO 80401-3275
Mailing address
14143 Denver West Pkwy Ste 100
Lakewood, CO 80401-3275
Phone (720) 594-5556
NPI Registry JSON
{
"created_epoch": "1654473600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1656547200000",
"number": "1154050128",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14143 DENVER WEST PKWY STE 100",
"city": "LAKEWOOD",
"state": "CO",
"postal_code": "804013275",
"telephone_number": "720-594-5556"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14143 DENVER WEST PKWY STE 100",
"city": "LAKEWOOD",
"state": "CO",
"postal_code": "804013275",
"telephone_number": "720-594-5556"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "THE 40 20 COLLECTIVE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2022-06-06",
"last_updated": "2022-06-30",
"certification_date": "2022-06-30",
"status": "A",
"authorized_official_last_name": "DOW",
"authorized_official_first_name": "MEGHAN",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "720-594-5556",
"authorized_official_credential": "DNP"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakewood, CO
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- Kathy Thai
- Kristin L Thanavaro
- Rachana Thapa
- The Body Mechanic, LLC
- The Federation of Families for Children'S Mental Health
- The Freedom Center
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All providers in Lakewood, CO · Psychiatric/Mental Health Nurse Practitioner in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 30, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.