Healthcare Provider Details

I. General information

NPI: 1447182464
Provider Name (Legal Business Name): GLACIER LILY THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CENTRE AVE STE 150
FORT COLLINS CO
80526-2107
US

IV. Provider business mailing address

1936 DERBY CT
FORT COLLINS CO
80526-2330
US

V. Phone/Fax

Practice location:
  • Phone: 970-620-8188
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LIA WOLFE
Title or Position: OWNER
Credential:
Phone: 850-582-2000