Healthcare Provider Details

I. General information

NPI: 1083491484
Provider Name (Legal Business Name): MICHELLE AND GLENN VROOMAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 10/14/2023
Certification Date: 10/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 ACADEMY CIR STE E
COLORADO SPRINGS CO
80909-1661
US

IV. Provider business mailing address

2130 ACADEMY CIR STE E
COLORADO SPRINGS CO
80909-1661
US

V. Phone/Fax

Practice location:
  • Phone: 719-459-2097
  • Fax: 719-418-6296
Mailing address:
  • Phone: 719-459-2097
  • Fax: 719-418-6296

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 Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. MICHELLE LYNN VROOMAN
Title or Position: THERAPIST/OWNER
Credential: LCSW
Phone: 719-459-2097