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NPI Code Detail

MEDICARE: CRAZY WISDOM JOURNEY, LLC

MEDICARE: CRAZY WISDOM JOURNEY, 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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YM0800XMental Health Counselor
3101YP2500XProfessional Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11497915706OTHERINDIVIDUAL NPI
21689951725OTHERGROUP/ORGANIZATIONAL NPI

General Provider Information

NPI Number : 1689951725
Entity Type Code : Organization
Provider Name (Legal Business Name) : CRAZY WISDOM JOURNEY, LLC
Provider Business Mailing Address
First Line : 5921 MIDDLEFIELD RD STE 100
Second Line :
City : LITTLETON
State : CO
Zip : 80123-2860
Country : US
Telephone Number : 303-515-0987
Fax Number : 720-726-7745
Provider Business Practice Location Address
First Line : 5921 MIDDLEFIELD RD STE 100
Second Line :
City : LITTLETON
State : CO
Zip : 80123-2860
Country : US
Telephone Number : 303-515-0987
Fax Number : 720-726-7745
Authorized Official
Title or Position : OWNER/PROVIDER
Name : DEBRA VELETA FOSTER
Credential : MAC, LAC, LPC-MHSP
Telephone Number : 303-515-0987
Provider Enumeration Date : 11/03/2011
Last Update Date : 07/20/2019

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Directions to “CRAZY WISDOM JOURNEY, LLC ” Practice Location

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