Healthcare Provider Details

I. General information

NPI: 1780356188
Provider Name (Legal Business Name): MOMENTUM COUNSELING AND CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 MILESTONE DR. SUITE 103
FT. COLLINS CO
80525-5761
US

IV. Provider business mailing address

2120 MILESTONE DR. SUITE 103
FT. COLLINS CO
80525-5761
US

V. Phone/Fax

Practice location:
  • Phone: 970-829-8780
  • Fax:
Mailing address:
  • Phone: 970-829-8780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DAMOND R DOTSON
Title or Position: BILLING MANAGER
Credential: PHD LMFT
Phone: 970-576-1717