Healthcare Provider Details

I. General information

NPI: 1326651621
Provider Name (Legal Business Name): KUUMBA THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2373 CENTRAL PARK BLVD UNIT 100
DENVER CO
80238-2300
US

IV. Provider business mailing address

PO BOX 201654
DENVER CO
80220-7654
US

V. Phone/Fax

Practice location:
  • Phone: 720-772-9814
  • Fax:
Mailing address:
  • Phone: 720-772-9814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHENELLE ROEBUCK
Title or Position: OWNER/ THERAPIST
Credential: LCSW
Phone: 720-772-9814