Healthcare Provider Details

I. General information

NPI: 1801251137
Provider Name (Legal Business Name): MUSIC THERAPY ROCKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2015
Last Update Date: 12/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 WASHINGTON ST
MONUMENT CO
80132-9179
US

IV. Provider business mailing address

PO BOX 1205
MONUMENT CO
80132-1205
US

V. Phone/Fax

Practice location:
  • Phone: 719-360-8420
  • Fax:
Mailing address:
  • Phone: 719-360-8420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE JACKSON
Title or Position: MUSIC THERAPIST
Credential: CNMT
Phone: 719-360-8420