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General NPI Number Information
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NPI Number | 1245536168
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Entity Type | Organization
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Legal Business Name | ACCENT ON LIFE, LLC
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Dates
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Enumeration Date | 02/10/2011
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Last Update Date | 02/10/2011
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Provider Practice Location Address
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Address Line | 1335 PHAY AVE SUITE H
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City | CANON CITY
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State | CO
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Zip | 81212-2334
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Country | US
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Telephone | 719-784-7522
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Fax | 719-269-1730
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Provider Business Mailing Address
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Address Line | PO BOX 681
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City | PENROSE
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State | CO
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Zip | 81240-0681
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Country | US
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Telephone | 719-784-7522
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Fax | 719-269-1730
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | MS. TERRI GORMAN
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Credential | LCSW
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Telephone | 719-784-7522
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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 | 993001
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License Number State | CO
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