Organization
INTENT REVIVAL
Active
Organization
INTENT REVIVAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FREYJA MAY LCSW (REGISTERED AGENT)
(970) 624-9807
Entity
Organization
Contact information
Practice address
1817 ORCHARD PL, FORT COLLINS, CO 80521-3323
(970) 624-9807
Mailing address
1817 ORCHARD PL, FORT COLLINS, CO 80521-3323
(970) 624-9807
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW.09925190
CO
Other
Enumeration date
02/20/2018
Last updated
02/20/2018
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