Healthcare Provider Details

I. General information

NPI: 1275712895
Provider Name (Legal Business Name): MONICA IBARRA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONICA SANCHEZ LCSW

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 VINCENT ST. ATTN: 21 MDOS/SGOW - FAMILY ADVOCACY
PETERSON AFB CO
80914
US

IV. Provider business mailing address

559 VINCENT ST. ATTN: 21 MDOS/SGOW - FAMILY ADVOCACY
PETERSON AFB CO
80914
US

V. Phone/Fax

Practice location:
  • Phone: 719-556-8943
  • Fax: 877-813-1756
Mailing address:
  • Phone: 719-556-8943
  • Fax: 877-813-1756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6465
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number885
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: