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General NPI Number Information
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NPI Number | 1528665593
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Entity Type | Organization
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Legal Business Name | ACHIEVE WHOLE RECOVERY, PC
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Dates
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Enumeration Date | 10/02/2020
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Last Update Date | 10/02/2020
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Provider Practice Location Address
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Address Line | 129 KANSAS AVE
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City | WALSENBURG
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State | CO
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Zip | 81089-1818
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Country | US
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Telephone | 719-373-9703
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Fax |
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Provider Business Mailing Address
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Address Line | 1115 ELKTON DR STE 300
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-3597
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Country | US
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Telephone | 719-373-9703
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Fax |
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Authorized Official
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Title or Position | PRESEDENT
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Name | RYAN L COLE
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Credential | PSYD
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Telephone | 719-632-4033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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