MEDICARE: SOPHIA CENTER FOR HEALING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	917	CO

General Provider Information

NPI Number	:	1013260116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOPHIA CENTER FOR HEALING

Provider Business Mailing Address
First Line	:	1776 S JACKSON ST STE 810
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-3807
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1776 S JACKSON ST STE 810
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-3807
Country	:	US
Telephone Number	:	720-457-3342
Fax Number	:

Authorized Official
Title or Position	:	LICENSED MARRIAGE & FAMILY THERAPIS
Name	:	JENNIFER GLICK
Credential	:	M.A., M.S.C.,LMFT
Telephone Number	:	720-457-3342

Provider Enumeration Date	:	10/26/2012
Last Update Date	:	10/26/2012

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Directions to “SOPHIA CENTER FOR HEALING ” Practice Location

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