=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841062551
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNTOLD STORIES PSYCHOTHERAPY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2023
-----------------------------------------------------
Last Update Date | 05/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1010 SANTA FE DR UNIT 418
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80204-4257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-805-8653
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1010 SANTA FE DR UNIT 418
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80204-4257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-931-4383
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER/CEO
-----------------------------------------------------
Name | TORI DIBONA
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 720-805-8653
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------