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Organization
SAMPLE THERAPY SERVICES
Active
Organization
SAMPLE THERAPY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CARMEN LOUISE SAMPLE LCSW, LAC (CEO)
(720) 684-6309
Entity
Organization
Contact information
Practice address
606 MOUNTAIN VIEW AVE, LONGMONT, CO 80501-2779
(303) 523-8057
Mailing address
606 MOUNTAIN VIEW AVE, LONGMONT, CO 80501-2779
(303) 523-8057
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
95109587
—
CO
Enumeration date
12/14/2009
Last updated
04/20/2026
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