Provider Demographics
NPI:1730774613
Name:YAMPA VALLEY PSYCHOTHERAPIST'S LLC
Entity type:Organization
Organization Name:YAMPA VALLEY PSYCHOTHERAPIST'S LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-999-7996
Mailing Address - Street 1:2045 W VICTORY WAY
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:CO
Mailing Address - Zip Code:81625-3439
Mailing Address - Country:US
Mailing Address - Phone:720-999-7996
Mailing Address - Fax:
Practice Address - Street 1:2045 W VICTORY WAY
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-3439
Practice Address - Country:US
Practice Address - Phone:720-999-7996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-03
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty