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General NPI Number Information
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NPI Number | 1245727742
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Entity Type | Organization
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Legal Business Name | RESONATE MUSIC THERAPY LLC
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Dates
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Enumeration Date | 04/19/2018
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Last Update Date | 04/19/2018
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Provider Practice Location Address
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Address Line | 4670 WINEWOOD VILLAGE DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80917-1221
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Country | US
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Telephone | 719-492-5282
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Fax |
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Provider Business Mailing Address
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Address Line | 4670 WINEWOOD VILLAGE DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80917-1221
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Country | US
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Telephone | 719-492-5282
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Fax |
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Authorized Official
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Title or Position | OWNER/MUSIC THERAPIST
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Name | MARISSA JAE FERL
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Credential | MT-BC
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Telephone | 719-492-5282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225A00000X
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Taxonomy Name | Music Therapist
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License Number | 12894
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License Number State | CO
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