Organization Name: | EXTREME SPORTS CAMP |
NPI Number: | 1669744637 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SALLIE BERNARD (EXECUTIVE DIRECTOR) |
Mailing Address: | 23286 Two Rivers Rd Suite 24-a Basalt |
State: | CO US |
Postal Code: | 816219285 |
Phone Number: | 9709273143 |
Fax Number: | |
NPI Enumeration Date: | 02/06/2012 |
NPI Last Update Date: | 02/06/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | 1534517 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |