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General NPI Number Information
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NPI Number | 1366195380
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Entity Type | Organization
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Legal Business Name | CHOCOLATE PEACH BONDING COMPANY
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Dates
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Enumeration Date | 01/31/2022
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 2520 W PINYON AVE
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City | GRAND JCT
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State | CO
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Zip | 81505-6913
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Country | US
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Telephone | 970-424-2577
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4955
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City | GRAND JCT
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State | CO
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Zip | 81502-4955
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Country | US
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Telephone | 970-424-2577
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JIMMY L BOND
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Credential | LPC
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Telephone | 970-424-2577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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