Healthcare Provider Details

I. General information

NPI: 1811891997
Provider Name (Legal Business Name): ROYALS LIGHT COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2518 MARINA ST
EVANS CO
80620-9595
US

IV. Provider business mailing address

2518 MARINA ST
EVANS CO
80620-9595
US

V. Phone/Fax

Practice location:
  • Phone: 970-584-6365
  • Fax:
Mailing address:
  • Phone: 970-584-6365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: CYNTHIA ILENE CHAVEZ
Title or Position: OWNER
Credential: LCP CACII
Phone: 970-584-6365