Provider Demographics
NPI:1770250300
Name:MONUMENTAL EXPERIENCES PLLC
Entity Type:Organization
Organization Name:MONUMENTAL EXPERIENCES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:W
Authorized Official - Last Name:LAVOO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC, LAC
Authorized Official - Phone:719-600-3011
Mailing Address - Street 1:6660 DELMONICO DR SUITE D 210
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919
Mailing Address - Country:US
Mailing Address - Phone:719-480-8848
Mailing Address - Fax:303-532-5079
Practice Address - Street 1:7660 GODDARD ST STE 234
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-8231
Practice Address - Country:US
Practice Address - Phone:719-600-3011
Practice Address - Fax:303-532-5079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-23
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty