Canyon Tree Psychotherapy, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

993043 Issued in CO

Legal business name

CANYON TREE PSYCHOTHERAPY, LLC

Practice address

9351 Grant St
480
Thornton, CO 80229-4358

Phone

(720) 442-4506

NPI assigned

Dec 12, 2016

Last updated

Dec 12, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ann M Bomberg, LCSWNPI 1255741237

Title

Owner/Practictioner

Phone

(720) 442-4506

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, and the practitioner matching its NPPES authorized official.

• Ann M Bomberg, LCSW

  • Clinical Social Worker
  • Longmont, CO
  • NPI 1255741237
  NPD (past) Authorized official

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

{
    "created_epoch": "1481500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481500800000",
    "number": "1720522626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11829 RIDGE PKWY",
            "address_2": "632",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800215079",
            "telephone_number": "720-442-4506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9351 GRANT ST",
            "address_2": "480",
            "city": "THORNTON",
            "state": "CO",
            "postal_code": "802294358",
            "telephone_number": "720-442-4506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON TREE PSYCHOTHERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-12",
        "last_updated": "2016-12-12",
        "status": "A",
        "authorized_official_last_name": "BOMBERG",
        "authorized_official_first_name": "ANN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/PRACTICTIONER",
        "authorized_official_telephone_number": "720-442-4506",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "993043",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Thornton, CO
• Providers in Thornton, 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 Dec 12, 2016; 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.