Healthcare Provider Details

I. General information

NPI: 1730711474
Provider Name (Legal Business Name): SKB THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2627 REDWING RD STE 220
FORT COLLINS CO
80526-6331
US

IV. Provider business mailing address

2627 REDWING RD STE 220
FORT COLLINS CO
80526-6331
US

V. Phone/Fax

Practice location:
  • Phone: 970-239-1377
  • Fax: 970-573-7785
Mailing address:
  • Phone: 970-239-1377
  • Fax: 970-573-7785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHANIE BAGWELL
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 720-507-7686