Provider Demographics
NPI:1003672387
Name:ALCHEMY COUNSELING, CONSULTATION, AND WELLNESS
Entity Type:Organization
Organization Name:ALCHEMY COUNSELING, CONSULTATION, AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:970-217-7796
Mailing Address - Street 1:2444 CROWN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-5821
Mailing Address - Country:US
Mailing Address - Phone:970-217-7796
Mailing Address - Fax:
Practice Address - Street 1:215 MATHEWS ST STE 300
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3451
Practice Address - Country:US
Practice Address - Phone:970-217-7796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1740653906Medicaid
CO1972053973Medicaid
CO1023635190Medicaid