Colorado Psych Clinic LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

COLORADO PSYCH CLINIC LLC

Practice address

615 N Nevada Ave Ste 1E
Colorado Springs, CO 80903-1075

Phone

(719) 726-1077

Fax

(719) 960-2933

NPI assigned

Apr 5, 2022

Reactivated

Apr 19, 2024

Last updated

Apr 15, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jacob Allen Wilson, PMHNP-BCNPI 1962029165

Title

Owner

Phone

(719) 726-1077

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 3

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.

• Jacob Allen Wilson, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Colorado Springs, CO
  • NPI 1962029165
  Authorized official Same address or phone
• Dean Joel Gainey, DNP, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Colorado Springs, CO
  • NPI 1598441289
  NPD
• Jessie Kuhn, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Colorado Springs, CO
  • NPI 1982473583
  NPD (past)

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

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776211200000",
    "number": "1851032643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 N NEVADA AVE STE 1E",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809031075",
            "telephone_number": "719-726-1077",
            "fax_number": "719-960-2933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 N NEVADA AVE STE 1E",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809031075",
            "telephone_number": "719-726-1077",
            "fax_number": "719-960-2933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLORADO PSYCH CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-05",
        "last_updated": "2026-04-15",
        "certification_date": "2026-04-15",
        "deactivation_date": "2024-04-03",
        "reactivation_date": "2024-04-19",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "719-726-1077",
        "authorized_official_credential": "PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000204851",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Psychiatric/Mental Health Nurse Practitioner in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.