Provider Demographics
NPI:1043753734
Name:AN INTUITIVE MIND COUNSELING CONSULTING & PSYCHOLOGICAL SERVICE
Entity Type:Organization
Organization Name:AN INTUITIVE MIND COUNSELING CONSULTING & PSYCHOLOGICAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:WILLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-984-0244
Mailing Address - Street 1:12835 EAST ARAPAHOE RD
Mailing Address - Street 2:TOWER II, SUITE 440
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-4037
Mailing Address - Country:US
Mailing Address - Phone:720-984-0244
Mailing Address - Fax:
Practice Address - Street 1:12835 EAST ARAPAHOE RD
Practice Address - Street 2:TOWER II, SUITE 440
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-4037
Practice Address - Country:US
Practice Address - Phone:720-984-0244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-29
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3874103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty