Healthcare Provider Details

I. General information

NPI: 1649621046
Provider Name (Legal Business Name): INTEGRATIVE BALANCE PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 E STUART ST STE 2240
FORT COLLINS CO
80525-5315
US

IV. Provider business mailing address

1182 GRAVES AVE UNIT C SUITE #2
ESTES PARK CO
80517-7742
US

V. Phone/Fax

Practice location:
  • Phone: 970-238-0268
  • Fax: 833-645-2560
Mailing address:
  • Phone: 970-238-0268
  • Fax: 970-692-2594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0012110
License Number StateCO

VIII. Authorized Official

Name: MR. WESLEY MARSHALL BOWMAN
Title or Position: PSYCHOTHERAPIST
Credential: MSED, LPC
Phone: 970-238-0268