Healthcare Provider Details

I. General information

NPI: 1972150415
Provider Name (Legal Business Name): ASHOKA MIND AND BODY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 PINYON DR
FRUITA CO
81521-6405
US

IV. Provider business mailing address

PO BOX 264
FRUITA CO
81521-0264
US

V. Phone/Fax

Practice location:
  • Phone: 970-623-4216
  • Fax: 970-549-1400
Mailing address:
  • Phone: 970-623-4216
  • Fax: 970-549-1400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY POTTER
Title or Position: LPC
Credential: MS
Phone: 970-623-4216