Healthcare Provider Details

I. General information

NPI: 1114698636
Provider Name (Legal Business Name): BREATHE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4689 W 20TH ST UNIT E
GREELEY CO
80634-3218
US

IV. Provider business mailing address

3513 38TH AVE
EVANS CO
80620-9107
US

V. Phone/Fax

Practice location:
  • Phone: 970-381-2164
  • Fax:
Mailing address:
  • Phone: 970-518-5266
  • Fax:

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
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RYAN ANDREW SMITH
Title or Position: OWNER
Credential: MA, LPC
Phone: 970-518-5266