Provider Demographics
NPI:1487012720
Name:MILE HIGH TRAUMA THERAPY CENTER
Entity Type:Organization
Organization Name:MILE HIGH TRAUMA THERAPY CENTER
Other - Org Name:REWILD THERAPY AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:720-295-9787
Mailing Address - Street 1:4225 S LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-4728
Mailing Address - Country:US
Mailing Address - Phone:720-295-9787
Mailing Address - Fax:
Practice Address - Street 1:4225 S LOGAN ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-4728
Practice Address - Country:US
Practice Address - Phone:720-295-9787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-01
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099226621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty