Healthcare Provider Details

I. General information

NPI: 1003672387
Provider Name (Legal Business Name): ALCHEMY COUNSELING, CONSULTATION, AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 MATHEWS ST STE 300
FORT COLLINS CO
80524-3451
US

IV. Provider business mailing address

2444 CROWN VIEW DR
FORT COLLINS CO
80526-5821
US

V. Phone/Fax

Practice location:
  • Phone: 970-217-7796
  • Fax:
Mailing address:
  • Phone: 970-217-7796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY SHAW
Title or Position: EXECUTIVE DIRECTOR
Credential: LPC
Phone: 970-217-7796