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General NPI Number Information
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NPI Number | 1215764360
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Entity Type | Organization
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Legal Business Name | INGRID VAN HAITSMA COUNSELING LLC
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Dates
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Enumeration Date | 09/13/2024
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 500 COFFMAN ST STE 204
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City | LONGMONT
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State | CO
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Zip | 80501-5445
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Country | US
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Telephone | 720-893-1683
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Fax |
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Provider Business Mailing Address
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Address Line | 44 POWDER HORN PL # 204
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City | LONGMONT
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State | CO
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Zip | 80504-1233
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Country | US
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Telephone | 616-915-8203
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Fax |
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Authorized Official
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Title or Position | THERAPIST/OWNER
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Name | INGRID VAN HAITSMA
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Credential | LCSW, LAC
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Telephone | 616-915-8203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) 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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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