Healthcare Provider Details

I. General information

NPI: 1750103404
Provider Name (Legal Business Name): FLOURISH COUNSELING & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N GOULD ST STE R
SHERIDAN WY
82801-6317
US

IV. Provider business mailing address

3030 S COLLEGE AVE UNIT 207
FORT COLLINS CO
80525-2557
US

V. Phone/Fax

Practice location:
  • Phone: 970-660-8048
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CASSIE THOMAS
Title or Position: OWNER
Credential: LPC
Phone: 970-660-8048