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General NPI Number Information
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NPI Number | 1609713338
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Entity Type | Organization
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Legal Business Name | BREAK THE MOLD THERAPY
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Dates
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Enumeration Date | 04/30/2026
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Last Update Date | 04/30/2026
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Provider Practice Location Address
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Address Line | 2601 RAINTREE DR APT Z02
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City | FORT COLLINS
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State | CO
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Zip | 80526-2478
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Country | US
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Telephone | 970-233-9740
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Fax |
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Provider Business Mailing Address
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Address Line | 2601 RAINTREE DR APT Z02 Z02
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City | FORT COLLINS
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State | CO
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Zip | 80526-2478
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Country | US
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Telephone | 970-233-9740
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LEIGHANNA NORDSTROM
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Credential | MA, LMFT
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Telephone | 970-233-9740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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