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General NPI Number Information
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NPI Number | 1376040964
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Entity Type | Organization
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Legal Business Name | INTUITIVE ART PLAY TRAUMA THERAPY COLORADO, LLC
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Dates
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Enumeration Date | 04/10/2018
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Last Update Date | 01/30/2019
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Provider Practice Location Address
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Address Line | 80 GARDEN CTR STE 120
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City | BROOMFIELD
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State | CO
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Zip | 80020-1735
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Country | US
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Telephone | 303-917-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 722 JULIAN CIR
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City | LAFAYETTE
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State | CO
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Zip | 80026-1164
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Country | US
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Telephone | 303-917-2600
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA KUCHINSKI
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Credential | MA, LPC
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Telephone | 303-917-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 0006211
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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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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