Healthcare Provider Details

I. General information

NPI: 1912494485
Provider Name (Legal Business Name): C. BLAIR SKINNER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 ZANG ST STE 212
BROOMFIELD CO
80021-8224
US

IV. Provider business mailing address

520 ZANG ST STE 212
BROOMFIELD CO
80021-8224
US

V. Phone/Fax

Practice location:
  • Phone: 303-460-3881
  • Fax: 303-460-7850
Mailing address:
  • Phone: 303-460-3881
  • Fax: 303-460-7850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT655
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateCO

VIII. Authorized Official

Name: MS. C. BLAIR SKINNER
Title or Position: OWNER/DIRECTOR
Credential: LMFT
Phone: 720-980-4034