MEDICARE: BREATHE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1154133502
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREATHE PLLC

Provider Business Mailing Address
First Line	:	412 ORILLA DEL LAGO
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-8922
Country	:	US
Telephone Number	:	970-232-5224
Fax Number	:

Provider Business Practice Location Address
First Line	:	412 ORILLA DEL LAGO
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-8922
Country	:	US
Telephone Number	:	970-232-5224
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KATIE RENEE NEWTON
Credential	:	LPC
Telephone Number	:	970-232-5224

Provider Enumeration Date	:	01/23/2025
Last Update Date	:	01/23/2025

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