Healthcare Provider Details

I. General information

NPI: 1609307669
Provider Name (Legal Business Name): EXUBERO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2903 ASPEN DR
LOVELAND CO
80538-2577
US

IV. Provider business mailing address

2903 ASPEN DR UNIT F
LOVELAND CO
80538-2577
US

V. Phone/Fax

Practice location:
  • Phone: 970-593-8196
  • Fax:
Mailing address:
  • Phone: 970-593-8196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW09924529
License Number StateCO

VIII. Authorized Official

Name: AMY J HALLAGAN
Title or Position: OWNER
Credential: LCSW
Phone: 970-593-8196