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General NPI Number Information
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NPI Number | 1053708883
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Entity Type | Organization
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Legal Business Name | NORTHERN COLORADO DIALECTICAL BEHAVIOR THERAPY, LLC
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Dates
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Enumeration Date | 04/20/2015
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Last Update Date | 06/12/2015
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Provider Practice Location Address
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Address Line | 1031 ROBERTSON ST
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City | FORT COLLINS
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State | CO
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Zip | 80524-3926
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Country | US
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Telephone | 970-443-0846
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Fax | 970-493-9113
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Provider Business Mailing Address
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Address Line | 1031 ROBERTSON ST
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City | FORT COLLINS
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State | CO
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Zip | 80524-3926
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Country | US
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Telephone | 970-443-0846
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Fax | 970-493-9113
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Authorized Official
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Title or Position | OWNER
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Name | KRISTEN COCHRAN-WARD
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Credential | LCSW
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Telephone | 970-443-0846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW00000329
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License Number State | CO
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