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General NPI Number Information
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NPI Number | 1891471181
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Entity Type | Organization
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Legal Business Name | QUIETUDE THERAPY SERVICES, PLLC
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Dates
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Enumeration Date | 06/22/2023
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Last Update Date | 06/22/2023
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Provider Practice Location Address
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Address Line | 7765 WADSWORTH BLVD # 746312
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City | ARVADA
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State | CO
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Zip | 80003-2117
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Country | US
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Telephone | 720-593-8794
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 746312
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City | ARVADA
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State | CO
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Zip | 80006-6312
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Country | US
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Telephone | 720-593-8794
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Fax |
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Authorized Official
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Title or Position | THERAPIST, OWNER
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Name | JESSICA NITALEE MEDSKER LACKEY
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Credential | LCSW
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Telephone | 720-593-8794
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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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