Provider Demographics
NPI:1801251137
Name:MUSIC THERAPY ROCKS
Entity type:Organization
Organization Name:MUSIC THERAPY ROCKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MUSIC THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:CNMT
Authorized Official - Phone:719-360-8420
Mailing Address - Street 1:PO BOX 1205
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-1205
Mailing Address - Country:US
Mailing Address - Phone:719-360-8420
Mailing Address - Fax:
Practice Address - Street 1:32 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9179
Practice Address - Country:US
Practice Address - Phone:719-360-8420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO20181078Medicaid