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General NPI Number Information
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NPI Number | 1316754708
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Entity Type | Organization
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Legal Business Name | CANDACE BOLZ THERAPY LLC
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Dates
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Enumeration Date | 12/18/2024
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 18285 ROLLER COASTER RD # 80132
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City | MONUMENT
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State | CO
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Zip | 80132-8352
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Country | US
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Telephone | 719-354-5237
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Fax |
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Provider Business Mailing Address
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Address Line | 18285 ROLLER COASTER RD # 80132
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City | MONUMENT
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State | CO
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Zip | 80132-8352
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Country | US
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Telephone | 303-875-7438
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | CANDACE BOLZ
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Credential | LCSW, LAC
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Telephone | 719-354-5237
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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 |
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License Number State |
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