| Abundant Life Therapy, Llc | |
|
1401 S Taft Ave Ste 206 Loveland CO 80537-6962 | |
| (307) 274-4398 | |
| Not Available |
| Full Name | Abundant Life Therapy, Llc |
|---|---|
| Speciality | Counselor |
| Location | 1401 S Taft Ave Ste 206, Loveland, Colorado |
| Authorized Official Name and Position | Debra Wilson (BILLING) |
| Authorized Official Contact | 3072222013 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Abundant Life Therapy, Llc Po Box 21511 Cheyenne WY 82003-7029 Ph: (307) 274-4398 | Abundant Life Therapy, Llc 1401 S Taft Ave Ste 206 Loveland CO 80537-6962 Ph: (307) 274-4398 |
| NPI Number | 1205314754 |
|---|---|
| Provider Enumeration Date | 08/06/2018 |
| Last Update Date | 09/01/2020 |
| Certification Date | 08/24/2020 |
| Medicare PECOS PAC ID | 7517310097 |
|---|---|
| Medicare Enrollment ID | O20240131004022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205314754 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Christopher B Teipel |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1154765501 PECOS PAC ID: 3971956459 Enrollment ID: I20240131004363 |
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