Healthcare Provider Details

I. General information

NPI: 1548894090
Provider Name (Legal Business Name): FUSION FUNCTIONAL WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2020
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 VALLEY RD
CANON CITY CO
81212-4291
US

IV. Provider business mailing address

465 VALLEY RD
CANON CITY CO
81212-4291
US

V. Phone/Fax

Practice location:
  • Phone: 719-458-8050
  • Fax:
Mailing address:
  • Phone: 970-903-5244
  • Fax: 719-745-7656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DARCY COLE
Title or Position: OWNER
Credential: DSW, LCSW, LAC
Phone: 970-903-5244