Healthcare Provider Details

I. General information

NPI: 1780156547
Provider Name (Legal Business Name): KW THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2018
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 MARKET ST FL 1
BASALT CO
81621-7401
US

IV. Provider business mailing address

PO BOX 270224
LITTLETON CO
80127-0004
US

V. Phone/Fax

Practice location:
  • Phone: 970-315-2375
  • Fax:
Mailing address:
  • Phone: 970-315-2375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. KRISTIN LYNNE WERNER
Title or Position: OWNER
Credential: PHD, LPC
Phone: 970-315-2375