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General NPI Number Information
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NPI Number | 1821772963
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Entity Type | Organization
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Legal Business Name | INNER REFUGE THERAPY
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Dates
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Enumeration Date | 06/09/2023
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 720 N MAIN ST STE 240
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City | PUEBLO
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State | CO
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Zip | 81003-3046
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Country | US
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Telephone | 719-203-7949
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Fax | 719-465-5282
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Provider Business Mailing Address
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Address Line | 720 N MAIN ST STE 240
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City | PUEBLO
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State | CO
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Zip | 81003-3046
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Country | US
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Telephone | 719-203-7949
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Fax | 719-465-5282
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Authorized Official
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Title or Position | OWNER/CEO
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Name | RACHEL DONOHUE-DUPLER
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Credential | LCSW
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Telephone | 719-306-1765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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