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General NPI Number Information
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NPI Number | 1215442868
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Entity Type | Organization
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Legal Business Name | REVEAL TO HEAL COUNSELING
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Dates
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Enumeration Date | 12/05/2017
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Last Update Date | 12/05/2017
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Provider Practice Location Address
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Address Line | 731 N WEBER ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-1049
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Country | US
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Telephone | 719-425-9661
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Fax | 719-633-3023
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Provider Business Mailing Address
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Address Line | 7990 WOODY CREEK DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80911-8331
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Country | US
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Telephone | 719-646-9259
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Fax |
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Authorized Official
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Title or Position | OWNER/COUNSELOR
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Name | TINA MARIE SALVATIERRA
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Credential | LCSW
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Telephone | 719-646-9259
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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 | CSW.00001771
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License Number State | CO
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