Healthcare Provider Details

I. General information

NPI: 1033730122
Provider Name (Legal Business Name): CENTER FOR MIND AND BODY THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 04/30/2020
Certification Date: 04/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 N WEBER ST STE 200
COLORADO SPRINGS CO
80903-1072
US

IV. Provider business mailing address

611 N WEBER ST STE 200
COLORADO SPRINGS CO
80903-1072
US

V. Phone/Fax

Practice location:
  • Phone: 309-230-2707
  • Fax:
Mailing address:
  • Phone: 309-230-2707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMY MARIE SCOTT
Title or Position: CO-OWNER/THERAPIST
Credential: LCSW
Phone: 309-230-2707