NPIMap

Organization Active NPI

Lifespan Psychiatry of Colorado

  • Psychiatric/Mental Health Nurse Practitioner
  • Grand Junction, CO
National Provider Identifier
1497360838
Registry record updated Oct 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
LIFESPAN PSYCHIATRY OF COLORADO
Practice address
2140 N 12TH St
Grand Junction, CO 81501-2916
Phone
(970) 579-0003
Fax
(970) 433-7671
NPI assigned
Sep 12, 2020
Last updated
Oct 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2024

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

Authorized official

Name
Carrie ShahbahramiNPI 1972070498
Title
Owner
Phone
(970) 579-0003

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Primary
Clinical Nurse SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 364S00000X

Addresses

Primary practice location

2140 N 12TH St
Grand Junction, CO 81501-2916

Mailing address

2140 N 12TH St
Grand Junction, CO 81501-2916
Phone (970) 579-0003

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210121000197 CO Part B Supplier - Clinic/Group Practice 0749694495 Receives reassigned benefits from 14 practitioners
7 other NPIs on this enrollment
Practice locations: Grand Junction, CO; Delta, CO

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D2205386Lifespan Psychiatry of Colorado2140 N 12TH St, Grand Junction, CO 81501Certificate of waiverDec 13, 2026

National Provider Directory

National Provider Directory
Tax ID family
Lifespan Psychiatry of Colorado Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1599868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728172800000",
    "number": "1497360838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2140 N 12TH ST",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815012916",
            "telephone_number": "970-579-0003",
            "fax_number": "970-433-7671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2140 N 12TH ST",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815012916",
            "telephone_number": "970-579-0003",
            "fax_number": "970-433-7671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESPAN PSYCHIATRY OF COLORADO",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-12",
        "last_updated": "2024-10-06",
        "certification_date": "2024-10-06",
        "status": "A",
        "authorized_official_last_name": "SHAHBAHRAMI",
        "authorized_official_first_name": "CARRIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "970-579-0003"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "364S00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Junction, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2024; 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.