=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699552117
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUIET SPIRIT COUNSELING PROFESSIONAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2023
-----------------------------------------------------
Last Update Date | 09/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 751 MALETA LN STE 202
-----------------------------------------------------
City | CASTLE ROCK
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80108-7607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-201-7397
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2371 MORNINGVIEW LN
-----------------------------------------------------
City | CASTLE ROCK
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80109-3708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-201-7397
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | MARIAN LIN MONDY
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 719-201-7397
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------