Provider Demographics
NPI:1336807676
Name:HEALING TRAILS COUNSELING AND THERAPEUTIC SERVICES
Entity type:Organization
Organization Name:HEALING TRAILS COUNSELING AND THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANI
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLISTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:720-300-2162
Mailing Address - Street 1:10200 W 44TH AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-2838
Mailing Address - Country:US
Mailing Address - Phone:720-300-2162
Mailing Address - Fax:
Practice Address - Street 1:10200 W 44TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-2838
Practice Address - Country:US
Practice Address - Phone:720-300-2162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-03
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1396197133OtherALTERNATIVE FAMILY SERVICES