Healthcare Provider Details

I. General information

NPI: 1477287332
Provider Name (Legal Business Name): EEMINISM THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 S CHERRY ST STE 630
DENVER CO
80246-1233
US

IV. Provider business mailing address

425 S CHERRY ST STE 630
DENVER CO
80246-1233
US

V. Phone/Fax

Practice location:
  • Phone: 720-295-5736
  • Fax:
Mailing address:
  • Phone: 720-295-5736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LISA TAFOLLA
Title or Position: PSYCHOTHERAPIST
Credential: LPCC
Phone: 720-295-5736