Organization
NEUROTHERAPY CENTER OF NORTHERN COLORADO, LLC
Active
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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