Provider Demographics
NPI:1396017240
Name:4US2HEAL
Entity type:Organization
Organization Name:4US2HEAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:DAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:719-634-1380
Mailing Address - Street 1:PO BOX 2354
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80901-2354
Mailing Address - Country:US
Mailing Address - Phone:719-634-1380
Mailing Address - Fax:
Practice Address - Street 1:702 W KIOWA ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-1422
Practice Address - Country:US
Practice Address - Phone:719-271-4583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2067174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty