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General NPI Number Information
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NPI Number | 1609307669
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Entity Type | Organization
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Legal Business Name | EXUBERO, LLC
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Dates
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Enumeration Date | 03/22/2017
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Last Update Date | 03/22/2017
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Provider Practice Location Address
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Address Line | 2903 ASPEN DR
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City | LOVELAND
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State | CO
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Zip | 80538-2577
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Country | US
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Telephone | 970-593-8196
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Fax |
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Provider Business Mailing Address
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Address Line | 2903 ASPEN DR UNIT F
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City | LOVELAND
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State | CO
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Zip | 80538-2577
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Country | US
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Telephone | 970-593-8196
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMY J HALLAGAN
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Credential | LCSW
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Telephone | 970-593-8196
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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 | CSW09924529
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License Number State | CO
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