| Sodawellness | |
|
174 Midland Ave Basalt CO 81621-8911 | |
| (303) 489-0420 | |
| Not Available |
| Full Name | Sodawellness |
|---|---|
| Speciality | Counselor - Professional |
| Location | 174 Midland Ave, Basalt, Colorado |
| Authorized Official Name and Position | James Soda (OWNER) |
| Authorized Official Contact | 3034890420 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sodawellness Po Box 4767 Basalt CO 81621-4767 Ph: () - | Sodawellness 174 Midland Ave Basalt CO 81621-8911 Ph: (303) 489-0420 |
| NPI Number | 1649633785 |
|---|---|
| Provider Enumeration Date | 04/04/2016 |
| Last Update Date | 04/04/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649633785 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | ACD.0000453 (Colorado) | Secondary |
| 101YP2500X | Counselor - Professional | LPC.0012446 (Colorado) | Primary |
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