Healthcare Provider Details

I. General information

NPI: 1083443337
Provider Name (Legal Business Name): MVH THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 RUSINA RD STE C
COLORADO SPRINGS CO
80907-8127
US

IV. Provider business mailing address

4820 RUSINA RD STE C
COLORADO SPRINGS CO
80907-8127
US

V. Phone/Fax

Practice location:
  • Phone: 512-970-3187
  • Fax:
Mailing address:
  • Phone: 512-970-3187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MICHELE M. VINCENT
Title or Position: OWNER
Credential: LCSW
Phone: 720-414-0100