Provider Demographics
NPI:1912640228
Name:THERAPY NEAR ME
Entity type:Organization
Organization Name:THERAPY NEAR ME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLERTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:970-710-9074
Mailing Address - Street 1:PO BOX 1233
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623-1233
Mailing Address - Country:US
Mailing Address - Phone:970-710-9074
Mailing Address - Fax:
Practice Address - Street 1:711 MAIN ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-1936
Practice Address - Country:US
Practice Address - Phone:970-710-9074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THERAPY NEAR ME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-14
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty