Healthcare Provider Details

I. General information

NPI: 1336821743
Provider Name (Legal Business Name): MOMENTUM COUNSELING AND CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 BASELINE RD STE 200
BOULDER CO
80303-2668
US

IV. Provider business mailing address

2120 MILESTONE DR STE 103
FORT COLLINS CO
80525-5761
US

V. Phone/Fax

Practice location:
  • Phone: 970-829-8780
  • Fax: 970-341-2074
Mailing address:
  • Phone: 970-829-8780
  • Fax: 970-341-2074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DAMOND DOTSON
Title or Position: BILLING MANAGER
Credential: PHD
Phone: 970-576-1717