Healthcare Provider Details

I. General information

NPI: 1134907876
Provider Name (Legal Business Name): KINTSUGI INSTITUTE OF THERAPEUTIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4584 VALLEYBROOK DR
HIGHLANDS RANCH CO
80130-6965
US

IV. Provider business mailing address

4584 VALLEYBROOK DR
HIGHLANDS RANCH CO
80130-6965
US

V. Phone/Fax

Practice location:
  • Phone: 615-392-4808
  • Fax:
Mailing address:
  • Phone: 615-392-4808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JARED HASLAM
Title or Position: CEO
Credential:
Phone: 720-706-9834