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General NPI Number Information
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NPI Number | 1366171738
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Entity Type | Organization
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Legal Business Name | FAMILY WELLNESS AND PLAY THERAPY
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Dates
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Enumeration Date | 06/09/2022
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 408 4TH AVE
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City | LONGMONT
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State | CO
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Zip | 80501-5508
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Country | US
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Telephone | 303-217-0727
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Fax |
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Provider Business Mailing Address
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Address Line | 219 PRATT ST
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City | LONGMONT
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State | CO
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Zip | 80501-5432
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Country | US
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Telephone | 307-421-9886
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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 | MRS. BETHANY GARRETT-MYERS
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Credential | LCSW
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Telephone | 307-421-9886
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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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