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General NPI Number Information
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NPI Number | 1891132627
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Entity Type | Organization
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Legal Business Name | PURA VIDA VOICES, LLP
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Dates
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Enumeration Date | 06/03/2013
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Last Update Date | 06/03/2013
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Provider Practice Location Address
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Address Line | 1624 BONFORTE BLVD STE C
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City | PUEBLO
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State | CO
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Zip | 81001-1680
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Country | US
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Telephone | 719-546-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 1624 BONFORTE BLVD STE C
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City | PUEBLO
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State | CO
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Zip | 81001-1680
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Country | US
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Telephone | 719-546-1300
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. WILLIAM FREDERICK STULTZ
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Credential | PH.D.
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Telephone | 719-546-1300
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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 | 1407
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 539
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License Number State | CO
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