Healthcare Provider Details

I. General information

NPI: 1275242935
Provider Name (Legal Business Name): SLOPESIDE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 11/21/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FIRST ST
GRANBY CO
80446
US

IV. Provider business mailing address

PO BOX 24591
SILVERTHORNE CO
80497-4591
US

V. Phone/Fax

Practice location:
  • Phone: 970-439-3109
  • Fax:
Mailing address:
  • Phone: 970-406-2620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: ANDREA BROWN
Title or Position: OWNER
Credential: MS, LAC, SAP, EMDR
Phone: 970-406-2620