Healthcare Provider Details

I. General information

NPI: 1821598301
Provider Name (Legal Business Name): REBOUND COLORADO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5275 MARSHALL ST STE 101
ARVADA CO
80002-3900
US

IV. Provider business mailing address

5275 MARSHALL ST STE 101
ARVADA CO
80002-3900
US

V. Phone/Fax

Practice location:
  • Phone: 303-435-6525
  • Fax:
Mailing address:
  • Phone: 303-435-6525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JANET LYNN RUIZ-BAILEY
Title or Position: OWNER
Credential: LPC, LAC
Phone: 719-334-0269