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General NPI Number Information
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NPI Number | 1780312298
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Entity Type | Organization
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Legal Business Name | FEARLESSLY AUTHENTIC PSYCHOLOGY, LLC
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Dates
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Enumeration Date | 08/11/2022
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Last Update Date | 08/16/2022
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Provider Practice Location Address
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Address Line | 777 S WADSWORTH BLVD STE 102
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City | LAKEWOOD
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State | CO
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Zip | 80226-4300
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Country | US
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Telephone | 913-208-4241
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Fax |
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Provider Business Mailing Address
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Address Line | 332 S CARR ST
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City | LAKEWOOD
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State | CO
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Zip | 80226-3015
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Country | US
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Telephone | 913-208-4241
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. KIMBERLY GARRISON
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Credential | PSY.D.
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Telephone | 913-208-4241
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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