=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457749830
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNBROKEN HEALING INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2015
-----------------------------------------------------
Last Update Date | 01/07/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8461 TURNPIKE DR SUITE 100
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80031-4376
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-341-4770
-----------------------------------------------------
Fax | 720-540-0535
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8461 TURNPIKE DR SUITE 100
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80031-4376
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-341-4770
-----------------------------------------------------
Fax | 720-540-0535
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. HEATHER EMERICH
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 720-341-4770
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 1721
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------