Organization Name: | INDEPTH THERAPY, LLC |
NPI Number: | 1003275439 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BETHANY BLANKENHEIM (CO-OWNER) |
Mailing Address: | 2095 W 6th Ave Suite 205 Broomfield |
State: | CO US |
Postal Code: | 800201870 |
Phone Number: | 7202322303 |
Fax Number: | |
NPI Enumeration Date: | 02/12/2016 |
NPI Last Update Date: | 02/12/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 6548 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |