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Organization
SAMPLE SERVICES
Active
Organization
SAMPLE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARMEN SAMPLE LCSW (CEO)
(303) 523-8057
Entity
Organization
Contact information
Practice address
606 MOUNTAIN VIEW AVE, LONGMONT, CO 80501-2779
(720) 684-6309
Mailing address
606 MOUNTAIN VIEW AVE, LONGMONT, CO 80501-2779
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
02/22/2016
Last updated
11/14/2025
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