Healthcare Provider Details

I. General information

NPI: 1295500049
Provider Name (Legal Business Name): PERSONAL MYTH COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8791 WOLFF CT
WESTMINSTER CO
80031-3600
US

IV. Provider business mailing address

8791 WOLFF CT
WESTMINSTER CO
80031-3600
US

V. Phone/Fax

Practice location:
  • Phone: 970-299-9183
  • Fax:
Mailing address:
  • Phone: 970-299-9183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MELISSA IVANNA MARTINEZ
Title or Position: THERAPIST
Credential: LPC
Phone: 970-299-9183