Healthcare Provider Details

I. General information

NPI: 1558135277
Provider Name (Legal Business Name): POLARIS WELLNESS GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7075 CAMPUS DR STE 202
COLORADO SPRINGS CO
80920-6524
US

IV. Provider business mailing address

7075 CAMPUS DR STE 202
COLORADO SPRINGS CO
80920-6524
US

V. Phone/Fax

Practice location:
  • Phone: 309-648-2348
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: JULIE MCLAUGHLIN
Title or Position: OFFICE MANAGER
Credential:
Phone: 803-409-8834