Provider Demographics
NPI:1912494485
Name:C. BLAIR SKINNER, LLC
Entity Type:Organization
Organization Name:C. BLAIR SKINNER, LLC
Other - Org Name:EARLY CHILDHOOD WELLNESS PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:C.
Authorized Official - Middle Name:BLAIR
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:720-980-4034
Mailing Address - Street 1:520 ZANG ST STE 212
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-8224
Mailing Address - Country:US
Mailing Address - Phone:303-460-3881
Mailing Address - Fax:303-460-7850
Practice Address - Street 1:520 ZANG ST STE 212
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-8224
Practice Address - Country:US
Practice Address - Phone:303-460-3881
Practice Address - Fax:303-460-7850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLMFT655106H00000X
CO225X00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty