Healthcare Provider Details

I. General information

NPI: 1518874007
Provider Name (Legal Business Name): AUTISTIC MENTOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4189 CHASM LAKE DRIVE
LOVELAND CO
80538
US

IV. Provider business mailing address

4189 CHASM LAKE DR
LOVELAND CO
80538-7192
US

V. Phone/Fax

Practice location:
  • Phone: 720-805-5878
  • Fax:
Mailing address:
  • Phone: 720-805-5878
  • 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 Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: ROBIN LOVE
Title or Position: COUNSELOR/COACH
Credential: MA, LPCC
Phone: 720-805-5878