Provider Demographics
NPI:1083491484
Name:MICHELLE AND GLENN VROOMAN LLC
Entity Type:Organization
Organization Name:MICHELLE AND GLENN VROOMAN LLC
Other - Org Name:INNER PEACE PSYCHOTHERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:VROOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:719-459-2097
Mailing Address - Street 1:2130 ACADEMY CIR STE E
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1661
Mailing Address - Country:US
Mailing Address - Phone:719-459-2097
Mailing Address - Fax:719-418-6296
Practice Address - Street 1:2130 ACADEMY CIR STE E
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1661
Practice Address - Country:US
Practice Address - Phone:719-459-2097
Practice Address - Fax:719-418-6296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty