Healthcare Provider Details

I. General information

NPI: 1518766633
Provider Name (Legal Business Name): SNOWY PEAK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

892 W SOUTH BOULDER RD
LOUISVILLE CO
80027-2453
US

IV. Provider business mailing address

892 W SOUTH BOULDER RD
LOUISVILLE CO
80027-2453
US

V. Phone/Fax

Practice location:
  • Phone: 978-514-4999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOANNE TARANTINO
Title or Position: PARTNER
Credential: LICSW
Phone: 978-514-4999