Provider Demographics
NPI:1104673334
Name:TAKE FLIGHT THERAPY
Entity type:Organization
Organization Name:TAKE FLIGHT THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP, CGT
Authorized Official - Phone:303-667-0955
Mailing Address - Street 1:5563 BOWRON PL
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-8622
Mailing Address - Country:US
Mailing Address - Phone:303-667-0955
Mailing Address - Fax:
Practice Address - Street 1:5563 BOWRON PL
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-8622
Practice Address - Country:US
Practice Address - Phone:303-667-0955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty