Healthcare Provider Details

I. General information

NPI: 1720804941
Provider Name (Legal Business Name): ALL-TERRAIN BEHAVIOR HEALTH GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1834 VINEWOOD LN STE 214
PUEBLO CO
81005-2559
US

IV. Provider business mailing address

6805 CORPORATE DR STE 120
COLORADO SPRINGS CO
80919-1977
US

V. Phone/Fax

Practice location:
  • Phone: 719-726-8811
  • Fax:
Mailing address:
  • Phone: 719-726-8811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TODD ROWE
Title or Position: CEO
Credential: PHD, LMFT
Phone: 719-229-8879