Healthcare Provider Details

I. General information

NPI: 1033046479
Provider Name (Legal Business Name): BODY REVERENCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2724 N OVERLAND TRAIL BOX 130
LAPORTE CO
80535-5001
US

IV. Provider business mailing address

2724 N OVERLAND TRAIL BOX 130
LAPORTE CO
80535-5001
US

V. Phone/Fax

Practice location:
  • Phone: 307-710-6790
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JAMIE HUNT
Title or Position: OWNER/MEMBER
Credential: LPC, RDN, CPT
Phone: 307-710-6790