=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386505055
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WINDING WILLOW PSYCHOTHERAPY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2025
-----------------------------------------------------
Last Update Date | 11/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2731 GLENDEVEY DR
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80538-2922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-829-8874
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2731 GLENDEVEY DR
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80538-2922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-829-8874
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL MENTAL HEALTH THERAPIST
-----------------------------------------------------
Name | JASPER JAMES WAITE
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 970-443-9809
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------