Healthcare Provider Details

I. General information

NPI: 1770250300
Provider Name (Legal Business Name): MONUMENTAL EXPERIENCES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7660 GODDARD ST STE 234
COLORADO SPRINGS CO
80920-8231
US

IV. Provider business mailing address

6660 DELMONICO DR SUITE D 210
COLORADO SPRINGS CO
80919
US

V. Phone/Fax

Practice location:
  • Phone: 719-600-3011
  • Fax: 303-532-5079
Mailing address:
  • Phone: 719-480-8848
  • Fax: 303-532-5079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. ABIGAIL W LAVOO
Title or Position: MANAGER/ADMINISTRATOR
Credential: PHD, LPC, LAC
Phone: 719-600-3011