Provider Demographics
NPI:1043737315
Name:PONDEROSA COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:PONDEROSA COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:REEDER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:720-951-1476
Mailing Address - Street 1:19753 E PIKES PEAK AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-7435
Mailing Address - Country:US
Mailing Address - Phone:720-542-3487
Mailing Address - Fax:720-542-3566
Practice Address - Street 1:19753 E PIKES PEAK AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138
Practice Address - Country:US
Practice Address - Phone:720-542-3487
Practice Address - Fax:720-542-3566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN0004453-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty