Provider Demographics
NPI:1396411609
Name:STACY LABAR THERAPY, LLC
Entity Type:Organization
Organization Name:STACY LABAR THERAPY, LLC
Other - Org Name:ROCKY MOUNTAIN KID THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:LABAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-886-5348
Mailing Address - Street 1:11154 HURON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2329
Mailing Address - Country:US
Mailing Address - Phone:303-886-5348
Mailing Address - Fax:
Practice Address - Street 1:11154 HURON ST STE 101
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-2329
Practice Address - Country:US
Practice Address - Phone:303-886-5348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-17
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO89832337Medicaid