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General NPI Number Information
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NPI Number | 1467947911
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Entity Type | Organization
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Legal Business Name | PLAN B THERAPY
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Dates
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Enumeration Date | 06/27/2018
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Last Update Date | 12/30/2021
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Provider Practice Location Address
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Address Line | 2620 E PROSPECT RD STE 190
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City | FORT COLLINS
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State | CO
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Zip | 80525-9098
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Country | US
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Telephone | 312-944-3565
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Fax |
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Provider Business Mailing Address
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Address Line | 456 QUINBY ST
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City | FORT COLLINS
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State | CO
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Zip | 80524-4933
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Country | US
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Telephone | 312-944-3565
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUZANNE BLAISING
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Credential | PHD
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Telephone | 312-944-3565
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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 | 149-009149
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License Number State | IL
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