Provider Demographics
NPI:1336517945
Name:GYPSY WIND RANCH, LLC
Entity Type:Organization
Organization Name:GYPSY WIND RANCH, LLC
Other - Org Name:GYPSY WIND COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:719-210-0668
Mailing Address - Street 1:3530 DOOLITTLE RD
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-8142
Mailing Address - Country:US
Mailing Address - Phone:719-210-0668
Mailing Address - Fax:
Practice Address - Street 1:3530 DOOLITTLE RD
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-8142
Practice Address - Country:US
Practice Address - Phone:719-210-0668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0011345101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty