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General NPI Number Information
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NPI Number | 1841054731
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Entity Type | Organization
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Legal Business Name | SAND CANYON THERAPY LLC
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Dates
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Enumeration Date | 02/12/2024
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 37 N MADISON ST
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City | CORTEZ
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State | CO
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Zip | 81321-3301
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Country | US
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Telephone | 970-570-3119
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 382
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City | DOLORES
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State | CO
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Zip | 81323-0382
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANNA DIAZ
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Credential | MS
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Telephone | 970-570-3119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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