Organization
NEUROTHERAPY CENTER OF NORTHERN COLORADO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MICHAELE DAWN JOHNSON LCSW (SOLE OWNER)
(970) 214-5712
Entity
Organization
Contact information
Practice address
503 REMINGTON ST STE 106, FORT COLLINS, CO 80524-3089
(970) 214-5712
(970) 315-0386
Mailing address
503 REMINGTON ST STE 106, FORT COLLINS, CO 80524-3089
(970) 214-5712
(970) 315-0386
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
992151
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
COA100485
MEDICARE GROUP PTAN
CO
01
—
COA100486
MEDICARE INDIVIDUAL PTAN
CO
Enumeration date
03/08/2011
Last updated
03/08/2011
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