Provider Demographics
NPI:1124493283
Name:ROCKY MOUNTAIN EQUINE ASSISTED PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:ROCKY MOUNTAIN EQUINE ASSISTED PSYCHOTHERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, LCSW
Authorized Official - Prefix:
Authorized Official - First Name:CARINA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:KELLENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:303-908-8853
Mailing Address - Street 1:1759 S LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3123
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22424 N TURKEY CREEK RD
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:CO
Practice Address - Zip Code:80465-9008
Practice Address - Country:US
Practice Address - Phone:303-697-7416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO09924062251S00000X
CO09923674251S00000X
1041C0700X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health