Ten Mile Health & Wellness LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

TEN MILE HEALTH & WELLNESS LLC

Practice address

114 Village Place
St 207
Dillon, CO 80435

Phone

(970) 455-9004

Fax

(949) 577-4247

NPI assigned

Apr 14, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Theresa Larkin Clark, MDNPI 1104015155

Title

President

Phone

(970) 455-9004

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Theresa L Clark, M.D.

  • Psychiatry Physician
  • Dillon, CO
  • NPI 1104015155

  CO, Psychiatry

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1618358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618358400000",
    "number": "1417538281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2098",
            "city": "DILLON",
            "state": "CO",
            "postal_code": "804352098",
            "telephone_number": "970-455-9004",
            "fax_number": "949-577-4247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 VILLAGE PLACE",
            "address_2": "ST 207",
            "city": "DILLON",
            "state": "CO",
            "postal_code": "80435",
            "telephone_number": "970-455-9004",
            "fax_number": "949-577-4247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEN MILE HEALTH & WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-14",
        "last_updated": "2021-04-14",
        "certification_date": "2021-04-14",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "LARKIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "970-455-9004",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000169353",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Summit Orthopedic Surgery Center, LLC
• Summit Psychotherapy, PLLC
• Summit Urgent Care at Dillon, LLC
• Hillary M Sunderland, LCSW, LAC
• Brian Tarola, DC
• Therese White MSW LCSW Therapeutic Services LLC
• Tree of Life Counseling, LLC
• Eric Michael Turner, BS, CAT, CAMS-I
• Nancy Elizabeth Turner, D.C.
• Andrea Uliano, APRN

• All providers in Dillon, CO
• Psychiatry Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.