Provider Demographics
NPI:1861156960
Name:SOLACE HEALING OF NORTHERN COLORADO
Entity type:Organization
Organization Name:SOLACE HEALING OF NORTHERN COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:LEIMBACH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:970-599-1205
Mailing Address - Street 1:109 CORONADO CT # 7
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4929
Mailing Address - Country:US
Mailing Address - Phone:970-599-1205
Mailing Address - Fax:
Practice Address - Street 1:109 CORONADO CT BLDG 7
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4929
Practice Address - Country:US
Practice Address - Phone:970-599-1205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty