Healthcare Provider Details

I. General information

NPI: 1144020322
Provider Name (Legal Business Name): HEALING FORGE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13526 JACKSON ST
THORNTON CO
80241-1463
US

IV. Provider business mailing address

13526 JACKSON ST
THORNTON CO
80241-1463
US

V. Phone/Fax

Practice location:
  • Phone: 509-899-7199
  • Fax:
Mailing address:
  • Phone: 509-899-7199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: FRED WASHBURN
Title or Position: OWNER
Credential: LPC
Phone: 970-795-2728