Healthcare Provider Details

I. General information

NPI: 1356082119
Provider Name (Legal Business Name): WATERCOLOR RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 COURT ST
PUEBLO CO
81003-2871
US

IV. Provider business mailing address

260 S DACONA DR
PUEBLO WEST CO
81007-1640
US

V. Phone/Fax

Practice location:
  • Phone: 719-469-0682
  • Fax:
Mailing address:
  • Phone: 719-469-0682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name: AMY ARMSTRONG
Title or Position: CLINICAL DIRECTOR
Credential: LPC, LAC
Phone: 303-638-8539