Provider Demographics
NPI:1043622756
Name:PARENTING CENTER, LLC
Entity Type:Organization
Organization Name:PARENTING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:719-201-0887
Mailing Address - Street 1:524 N TEJON ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-4926
Mailing Address - Country:US
Mailing Address - Phone:719-201-0887
Mailing Address - Fax:480-275-3789
Practice Address - Street 1:524 N TEJON ST
Practice Address - Street 2:SUITE 3 - UPSTAIRS
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-4926
Practice Address - Country:US
Practice Address - Phone:719-201-0887
Practice Address - Fax:480-275-3789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.09923269251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO39383075Medicaid
CO39383075Medicaid