Healthcare Provider Details

I. General information

NPI: 1013288661
Provider Name (Legal Business Name): WARRIOR RELAXATION RESPONSE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 AIRPORT RD
COLORADO SPRINGS CO
80910-3119
US

IV. Provider business mailing address

2535 AIRPORT RD
COLORADO SPRINGS CO
80910-3119
US

V. Phone/Fax

Practice location:
  • Phone: 719-339-6313
  • Fax:
Mailing address:
  • Phone: 719-339-6313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5274
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number255
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1184
License Number StateCO

VIII. Authorized Official

Name: MS. SALLIE ANNETTE HARPER
Title or Position: ADMINISTRATOR OF CLINICAL SERVICES
Credential: LPC
Phone: 719-963-0428