MEDICARE: COLORADO THERAPY COLLECTIVE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	106H00000X	Marriage & Family Therapist
3	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1518709005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO THERAPY COLLECTIVE LLC

Provider Business Mailing Address
First Line	:	2406 W 32ND AVE STE D
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-3373
Country	:	US
Telephone Number	:	720-204-8589
Fax Number	:

Provider Business Practice Location Address
First Line	:	2406 W 32ND AVE STE D
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-3373
Country	:	US
Telephone Number	:	720-204-8589
Fax Number	:

Authorized Official
Title or Position	:	OWNER / DIRECTOR
Name	:	NANCY BRITTAIN
Credential	:	LCSW
Telephone Number	:	720-204-8589

Provider Enumeration Date	:	06/06/2024
Last Update Date	:	06/06/2024

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