Healthcare Provider Details

I. General information

NPI: 1528995628
Provider Name (Legal Business Name): TRAILHEAD THEARPY COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 FOREST AVE
CANON CITY CO
81212-5030
US

IV. Provider business mailing address

627 FOREST AVE
CANON CITY CO
81212-5030
US

V. Phone/Fax

Practice location:
  • Phone: 720-441-6002
  • Fax:
Mailing address:
  • Phone: 720-441-6002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: GARRETT HUMPHRIES
Title or Position: OWNER
Credential: MA LMFT
Phone: 720-441-6002