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General NPI Number Information
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NPI Number | 1861156960
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Entity Type | Organization
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Legal Business Name | SOLACE HEALING OF NORTHERN COLORADO
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Dates
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Enumeration Date | 10/25/2021
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Last Update Date | 05/31/2023
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Provider Practice Location Address
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Address Line | 109 CORONADO CT BLDG 7
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City | FORT COLLINS
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State | CO
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Zip | 80525-4929
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Country | US
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Telephone | 970-599-1205
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Fax |
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Provider Business Mailing Address
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Address Line | 109 CORONADO CT # 7
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City | FORT COLLINS
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State | CO
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Zip | 80525-4929
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Country | US
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Telephone | 970-599-1205
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | JENNIFER NICOLE LEIMBACH
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Credential | LCSW
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Telephone | 970-599-1205
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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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