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General NPI Number Information
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NPI Number | 1972310811
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Entity Type | Organization
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Legal Business Name | SAXIFRAGE COUNSELING, LLC
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Dates
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Enumeration Date | 12/13/2024
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 301 E MAIN ST STE 205
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City | BUENA VISTA
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State | CO
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Zip | 81211-5011
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Country | US
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Telephone | 719-581-9720
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1
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City | BUENA VISTA
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State | CO
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Zip | 81211-0001
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Country | US
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Telephone | 719-581-9720
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KARI VANDERBURG
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Credential | LPC
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Telephone | 719-581-9720
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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 |
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License Number State |
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