Provider Demographics
NPI:1316754708
Name:CANDACE BOLZ THERAPY LLC
Entity type:Organization
Organization Name:CANDACE BOLZ THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LAC
Authorized Official - Phone:719-354-5237
Mailing Address - Street 1:18285 ROLLER COASTER RD # 80132
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-8352
Mailing Address - Country:US
Mailing Address - Phone:303-875-7438
Mailing Address - Fax:
Practice Address - Street 1:18285 ROLLER COASTER RD # 80132
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-8352
Practice Address - Country:US
Practice Address - Phone:719-354-5237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty