Healthcare Provider Details

I. General information

NPI: 1619541257
Provider Name (Legal Business Name): SANDY RENEE GOLIAS MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4610 SPRING CANYON HTS APT 301
COLORADO SPRINGS CO
80907-3459
US

IV. Provider business mailing address

4610 SPRING CANYON HTS APT 301
COLORADO SPRINGS CO
80907-3459
US

V. Phone/Fax

Practice location:
  • Phone: 440-537-9471
  • Fax:
Mailing address:
  • Phone: 440-537-9471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number13653
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: