Healthcare Provider Details

I. General information

NPI: 1871289967
Provider Name (Legal Business Name): HEART WILD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4704 HARLAN ST STE 511
DENVER CO
80212-7427
US

IV. Provider business mailing address

4704 HARLAN ST STE 511
DENVER CO
80212-7427
US

V. Phone/Fax

Practice location:
  • Phone: 720-635-9045
  • Fax:
Mailing address:
  • Phone: 720-635-9045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: SARAH MURRAY
Title or Position: OWNER/THERAPIST
Credential:
Phone: 720-635-9045