Provider Demographics
NPI:1346863123
Name:ACTION POTENTIAL HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:ACTION POTENTIAL HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:970-215-4030
Mailing Address - Street 1:506 GRAND ESTATES DR UNIT D
Mailing Address - Street 2:
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-8939
Mailing Address - Country:US
Mailing Address - Phone:970-215-4030
Mailing Address - Fax:
Practice Address - Street 1:157 W ELKHORN AVE
Practice Address - Street 2:
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517
Practice Address - Country:US
Practice Address - Phone:970-215-4030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty