Healthcare Provider Details

I. General information

NPI: 1134895139
Provider Name (Legal Business Name): YOUR WELLNESS JOURNEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 10/26/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1780 S BELLAIRE ST
DENVER CO
80222-4307
US

IV. Provider business mailing address

1780 S BELLAIRE ST
DENVER CO
80222-4307
US

V. Phone/Fax

Practice location:
  • Phone: 303-489-1799
  • Fax:
Mailing address:
  • Phone: 303-489-1799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANALICE HOFFENBERG
Title or Position: OWNER
Credential: MD
Phone: 303-489-1799