Provider Demographics
NPI:1174298954
Name:ALTITUDE WELLNESS COACHING
Entity Type:Organization
Organization Name:ALTITUDE WELLNESS COACHING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-868-3702
Mailing Address - Street 1:1885 PARKDALE CT
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-2410
Mailing Address - Country:US
Mailing Address - Phone:509-868-3702
Mailing Address - Fax:
Practice Address - Street 1:2204 18TH AVE STE 140
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-9711
Practice Address - Country:US
Practice Address - Phone:509-868-3702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health