Healthcare Provider Details

I. General information

NPI: 1245727742
Provider Name (Legal Business Name): RESONATE MUSIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4670 WINEWOOD VILLAGE DR
COLORADO SPRINGS CO
80917-1221
US

IV. Provider business mailing address

4670 WINEWOOD VILLAGE DR
COLORADO SPRINGS CO
80917-1221
US

V. Phone/Fax

Practice location:
  • Phone: 719-492-5282
  • Fax:
Mailing address:
  • Phone: 719-492-5282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number12894
License Number StateCO

VIII. Authorized Official

Name: MARISSA JAE FERL
Title or Position: OWNER/MUSIC THERAPIST
Credential: MT-BC
Phone: 719-492-5282