Healthcare Provider Details

I. General information

NPI: 1730845843
Provider Name (Legal Business Name): BRAIN-BODY-SPIRIT- LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 GALLINA PEAK
SANTA FE NM
87508-1439
US

IV. Provider business mailing address

12128 W COOPER DR
LITTLETON CO
80127-4861
US

V. Phone/Fax

Practice location:
  • Phone: 720-470-7980
  • Fax:
Mailing address:
  • Phone: 720-470-7980
  • 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

VIII. Authorized Official

Name: LIA BILLINGTON
Title or Position: OWNER
Credential: PHD
Phone: 720-470-7980