MEDICARE: WINDS OF CHANGE COUNSELING, LLC

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1114638350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINDS OF CHANGE COUNSELING, LLC

Provider Business Mailing Address
First Line	:	3030 S COLLEGE AVE UNIT 200A
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2557
Country	:	US
Telephone Number	:	970-315-2293
Fax Number	:

Provider Business Practice Location Address
First Line	:	873 CLEVELAND AVE STE 104
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80537-4716
Country	:	US
Telephone Number	:	970-315-2293
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MONICA MASSARO GARCIA
Credential	:
Telephone Number	:	925-337-0415

Provider Enumeration Date	:	12/08/2022
Last Update Date	:	02/09/2024

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