Intent Revival

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW.09925190 Issued in CO

Legal business name

INTENT REVIVAL

Practice address

1817 Orchard PL
Fort Collins, CO 80521-3323

Phone

(970) 624-9807

NPI assigned

Feb 20, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Freyja May, LCSWNPI 1427422187

Title

Registered Agent

Phone

(970) 624-9807

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Freyja W May, LCSW, MSW

  • Clinical Social Worker
  • Fort Collins, CO
  • NPI 1427422187
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1519084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519084800000",
    "number": "1457851925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1817 ORCHARD PL",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805213323",
            "telephone_number": "970-624-9807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1817 ORCHARD PL",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805213323",
            "telephone_number": "970-624-9807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTENT REVIVAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-20",
        "last_updated": "2018-02-20",
        "status": "A",
        "authorized_official_last_name": "MAY",
        "authorized_official_first_name": "FREYJA",
        "authorized_official_title_or_position": "REGISTERED AGENT",
        "authorized_official_telephone_number": "970-624-9807",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "CSW.09925190",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Integrative Life MD
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• Integrative Therapies of Co LLC
• Interim Healthcare of Fort Collins, Inc.
• Interim Healthcare of Fort Collins, Inc.
• Interim Healthcare of Fort Collins, Inc.
• Internal Medicine Clinic Inc.
• Internal Medicine Clinic Inc.

• Clinical Social Worker in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Clinical Social Worker in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.