Healthcare Provider Details

I. General information

NPI: 1184535478
Provider Name (Legal Business Name): THE REFINERY FOR CHANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5710 S JULIAN ST
LITTLETON CO
80123-2881
US

IV. Provider business mailing address

5710 S JULIAN ST
LITTLETON CO
80123-2881
US

V. Phone/Fax

Practice location:
  • Phone: 720-670-9872
  • Fax:
Mailing address:
  • Phone: 720-670-9872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. MANDY KIEBLER
Title or Position: OWNER
Credential: LAC
Phone: 720-670-9872