Provider Demographics
NPI:1790441442
Name:PEACEFUL PAWS THERAPY, LLC
Entity Type:Organization
Organization Name:PEACEFUL PAWS THERAPY, LLC
Other - Org Name:PEACEFUL PAWS THERAPY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:LEAH
Authorized Official - Last Name:STAPLES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LAC
Authorized Official - Phone:970-460-4149
Mailing Address - Street 1:11236 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-9392
Mailing Address - Country:US
Mailing Address - Phone:970-460-4149
Mailing Address - Fax:
Practice Address - Street 1:11236 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-9392
Practice Address - Country:US
Practice Address - Phone:970-460-4149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-16
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1679979165OtherNPI