Healthcare Provider Details

I. General information

NPI: 1114752995
Provider Name (Legal Business Name): FELLOW TRAVELERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 RUFFINO DR
COLORADO SPRINGS CO
80921-3875
US

IV. Provider business mailing address

1975 RUFFINO DR
COLORADO SPRINGS CO
80921-3875
US

V. Phone/Fax

Practice location:
  • Phone: 303-551-3863
  • Fax:
Mailing address:
  • Phone: 303-551-3863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: STEVEN WILLSON
Title or Position: OWNER
Credential: MA, LPC
Phone: 303-551-3863