Provider Demographics
NPI:1205237450
Name:INTEGRATIVE PSYCHOTHERAPY AND NUTRITION COUNSELING
Entity type:Organization
Organization Name:INTEGRATIVE PSYCHOTHERAPY AND NUTRITION COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:P
Authorized Official - Last Name:CARRON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MA, LPC
Authorized Official - Phone:303-359-9292
Mailing Address - Street 1:4490 TELLER ST
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-3406
Mailing Address - Country:US
Mailing Address - Phone:303-359-9292
Mailing Address - Fax:
Practice Address - Street 1:3500 E 17TH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1813
Practice Address - Country:US
Practice Address - Phone:303-359-9292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5735251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health