Provider Demographics
NPI:1326651621
Name:KUUMBA THERAPY, LLC
Entity Type:Organization
Organization Name:KUUMBA THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHENELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROEBUCK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:720-772-9814
Mailing Address - Street 1:PO BOX 201654
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-7654
Mailing Address - Country:US
Mailing Address - Phone:720-772-9814
Mailing Address - Fax:
Practice Address - Street 1:2373 CENTRAL PARK BLVD UNIT 100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-2300
Practice Address - Country:US
Practice Address - Phone:720-772-9814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-26
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health