Provider Demographics
NPI:1477232106
Name:COALTA THERAPY AND WELLNESS L.L.C.
Entity Type:Organization
Organization Name:COALTA THERAPY AND WELLNESS L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ L.C.S.W.
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACIAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:720-583-5256
Mailing Address - Street 1:5670 W 110TH PL
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80020-3244
Mailing Address - Country:US
Mailing Address - Phone:310-408-3339
Mailing Address - Fax:
Practice Address - Street 1:8791 WOLFF CT STE 200
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-3693
Practice Address - Country:US
Practice Address - Phone:720-583-5256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty