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General NPI Number Information
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NPI Number | 1023813979
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Entity Type | Organization
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Legal Business Name | BASECAMP RECOVERY, LLC
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Dates
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Enumeration Date | 02/14/2025
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 471 S BALDWIN ST STE 301
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City | WOODLAND PARK
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State | CO
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Zip | 80863-3218
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Country | US
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Telephone | 719-694-9739
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Fax |
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Provider Business Mailing Address
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Address Line | 225 E CHEYENNE MOUNTAIN BLVD STE 205
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906-3700
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Country | US
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Telephone | 719-694-9739
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NATE WILSON
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Credential |
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Telephone | 719-640-0668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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