Healthcare Provider Details

I. General information

NPI: 1174353742
Provider Name (Legal Business Name): REMOTE RELIEF TRAUMA THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 16TH ST STE 1460
DENVER CO
80202-5202
US

IV. Provider business mailing address

110 16TH ST STE 1460
DENVER CO
80202-5202
US

V. Phone/Fax

Practice location:
  • Phone: 970-818-0566
  • Fax:
Mailing address:
  • Phone: 970-818-0566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: REBECCA CASTLE-WALLER
Title or Position: OWNER
Credential: LCSW
Phone: 970-818-0566