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General NPI Number Information
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NPI Number | 1699485292
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Entity Type | Organization
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Legal Business Name | ROCKY MOUNTAIN SYSTEMIC THERAPY LLC
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Dates
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Enumeration Date | 12/05/2022
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 149 W OAK ST STE 110
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City | FORT COLLINS
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State | CO
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Zip | 80524-7110
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Country | US
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Telephone | 541-236-5026
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Fax |
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Provider Business Mailing Address
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Address Line | 149 W OAK ST STE 110
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City | FORT COLLINS
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State | CO
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Zip | 80524-7110
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Country | US
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Telephone | 541-236-5026
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | DAMOND DOTSON
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Credential | PHD
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Telephone | 970-576-1717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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