Healthcare Provider Details

I. General information

NPI: 1174381875
Provider Name (Legal Business Name): GRAND VALLEY INTEGRATIVE COUNSELING, PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2024
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 BRYAN LOOP
PARACHUTE CO
81635-7708
US

IV. Provider business mailing address

71 BRYAN LOOP
PARACHUTE CO
81635-7708
US

V. Phone/Fax

Practice location:
  • Phone: 970-414-0801
  • Fax:
Mailing address:
  • Phone: 970-414-0801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY SMITH
Title or Position: PROFESSIONAL COUNSELOR
Credential: LAC, LPC
Phone: 970-414-0801