MEDICARE: MEANING- CENTERED EMDR, INC.

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1215400759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEANING- CENTERED EMDR, INC.

Provider Business Mailing Address
First Line	:	2350 G RD STE 2
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-2303
Country	:	US
Telephone Number	:	970-697-7995
Fax Number	:	833-490-1313

Provider Business Practice Location Address
First Line	:	2350 G RD STE 2
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-2303
Country	:	US
Telephone Number	:	970-697-7995
Fax Number	:	833-490-1313

Authorized Official
Title or Position	:	OWNER
Name	:	MAC FISH
Credential	:	LPC
Telephone Number	:	970-697-7995

Provider Enumeration Date	:	01/08/2019
Last Update Date	:	01/27/2021

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