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General NPI Number Information
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NPI Number | 1770250300
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Entity Type | Organization
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Legal Business Name | MONUMENTAL EXPERIENCES PLLC
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Dates
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Enumeration Date | 08/23/2021
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Last Update Date | 08/30/2021
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Provider Practice Location Address
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Address Line | 7660 GODDARD ST STE 234
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-8231
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Country | US
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Telephone | 719-600-3011
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Fax | 303-532-5079
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Provider Business Mailing Address
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Address Line | 6660 DELMONICO DR SUITE D 210
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City | COLORADO SPRINGS
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State | CO
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Zip | 80919
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Country | US
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Telephone | 719-480-8848
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Fax | 303-532-5079
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Authorized Official
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Title or Position | MANAGER/ADMINISTRATOR
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Name | DR. ABIGAIL W LAVOO
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Credential | PHD, LPC, LAC
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Telephone | 719-600-3011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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