Healthcare Provider Details

I. General information

NPI: 1508785387
Provider Name (Legal Business Name): WAVES OF WELLNESS PSYCHOTHERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 VALLEY FORGE AVE
FORT COLLINS CO
80526-1650
US

IV. Provider business mailing address

2021 VALLEY FORGE AVE
FORT COLLINS CO
80526-1650
US

V. Phone/Fax

Practice location:
  • Phone: 970-658-9943
  • Fax:
Mailing address:
  • Phone: 970-658-9943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: CHANDA D ELKINS
Title or Position: MANAGING MEMBER LCSW
Credential:
Phone: 970-232-6881