Healthcare Provider Details

I. General information

NPI: 1437964624
Provider Name (Legal Business Name): VIRYA COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 18TH AVE STE 212
LONGMONT CO
80501-9723
US

IV. Provider business mailing address

2204 18TH AVE STE 212
LONGMONT CO
80501-9723
US

V. Phone/Fax

Practice location:
  • Phone: 720-593-4701
  • Fax:
Mailing address:
  • Phone: 720-593-4701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: ZACHARY M KRUGER
Title or Position: CO-OWNER
Credential: LPC
Phone: 720-593-4701