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General NPI Number Information
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NPI Number | 1124493283
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Entity Type | Organization
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Legal Business Name | ROCKY MOUNTAIN EQUINE ASSISTED PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 12/01/2015
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Last Update Date | 12/01/2015
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Provider Practice Location Address
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Address Line | 22424 N TURKEY CREEK RD
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City | MORRISON
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State | CO
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Zip | 80465-9008
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Country | US
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Telephone | 303-697-7416
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Fax |
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Provider Business Mailing Address
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Address Line | 1759 S LOGAN ST
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City | DENVER
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State | CO
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Zip | 80210-3123
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER, LCSW
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Name | CARINA NICOLE KELLENBERGER
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Credential | LCSW
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Telephone | 303-908-8853
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 09924062
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 09923674
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1041C0700X
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License Number State |
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