Provider Demographics
NPI:1003275439
Name:INDEPTH THERAPY, LLC
Entity Type:Organization
Organization Name:INDEPTH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANKENHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:720-232-2303
Mailing Address - Street 1:1008 DEPOT HILL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-6724
Mailing Address - Country:US
Mailing Address - Phone:720-232-2303
Mailing Address - Fax:720-358-0846
Practice Address - Street 1:1008 DEPOT HILL RD STE 200
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-6724
Practice Address - Country:US
Practice Address - Phone:720-232-2303
Practice Address - Fax:720-358-0846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-12
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty