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General NPI Number Information
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NPI Number | 1871020594
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Entity Type | Organization
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Legal Business Name | POWER-UP PERFORMANCE LLC
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Dates
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Enumeration Date | 05/12/2017
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Last Update Date | 05/12/2017
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Provider Practice Location Address
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Address Line | 631 S DEPEW ST
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City | LAKEWOOD
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State | CO
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Zip | 80226-4845
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Country | US
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Telephone | 303-547-0743
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Fax |
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Provider Business Mailing Address
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Address Line | 631 S DEPEW ST
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City | LAKEWOOD
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State | CO
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Zip | 80226-4845
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Country | US
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Telephone | 303-547-0743
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Fax |
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Authorized Official
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Title or Position | LEAD CLINICIAN
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Name | MR. MICHAEL HARDIN
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Credential | M.A., LPC, NCC
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Telephone | 303-547-0743
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | CO
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