Provider Demographics
NPI:1043455769
Name:BRIDGE TO AWARENESS COUNSELING CENTER
Entity Type:Organization
Organization Name:BRIDGE TO AWARENESS COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:DARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-471-2514
Mailing Address - Street 1:5698 S HWY 85 # 87
Mailing Address - Street 2:SUITE 104 AND 105
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-1465
Mailing Address - Country:US
Mailing Address - Phone:719-390-4652
Mailing Address - Fax:719-390-5728
Practice Address - Street 1:5698 S HWY 85
Practice Address - Street 2:SUITE 104
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-1465
Practice Address - Country:US
Practice Address - Phone:719-390-4652
Practice Address - Fax:719-690-4126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1110-01101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO39558258Medicaid