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General NPI Number Information
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NPI Number | 1699304626
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Entity Type | Organization
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Legal Business Name | SPERANZA RANCH LLC
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Dates
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Enumeration Date | 04/02/2020
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 300 W SOUTH AVE UNIT 514
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City | WOODLAND PARK
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State | CO
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Zip | 80863-2344
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Country | US
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Telephone | 719-210-1460
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 514
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City | WOODLAND PARK
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State | CO
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Zip | 80866-0514
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Country | US
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Telephone | 719-210-1460
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Fax |
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Authorized Official
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Title or Position | OWNER/ CLINICAL SUPERVISOR
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Name | JENNIFER PIERCE
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Credential | LAC, LADAC
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Telephone | 719-210-1460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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