Healthcare Provider Details

I. General information

NPI: 1447772454
Provider Name (Legal Business Name): INTEGRATED THERAPY OF NORTHERN COLORADO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 PARKVIEW DR
FORT COLLINS CO
80525-2734
US

IV. Provider business mailing address

PO BOX 697
FORT COLLINS CO
80522-0697
US

V. Phone/Fax

Practice location:
  • Phone: 970-492-5544
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: SABRA CHAVEZ
Title or Position: OWNER/THERAPIST
Credential: MM, MT-BC
Phone: 970-492-5544