Provider Demographics
NPI:1780283150
Name:PASSAGES THERAPY
Entity type:Organization
Organization Name:PASSAGES THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAFF
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:303-630-9433
Mailing Address - Street 1:629 STONEBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-7779
Mailing Address - Country:US
Mailing Address - Phone:303-630-9433
Mailing Address - Fax:
Practice Address - Street 1:600 S. AIRPORT RD. BLDG A STE G
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-6476
Practice Address - Country:US
Practice Address - Phone:303-630-9433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-18
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO58130250Medicaid