Provider Demographics
NPI:1053508986
Name:FAMILY LIFE COUNSELING, P.C.
Entity Type:Organization
Organization Name:FAMILY LIFE COUNSELING, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DYK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:720-274-5270
Mailing Address - Street 1:6240 S MAIN ST
Mailing Address - Street 2:SUITE #265
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-5376
Mailing Address - Country:US
Mailing Address - Phone:720-274-5270
Mailing Address - Fax:720-274-5267
Practice Address - Street 1:6240 S MAIN ST
Practice Address - Street 2:SUITE #265
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-5376
Practice Address - Country:US
Practice Address - Phone:720-274-5270
Practice Address - Fax:720-274-5267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2235101YP2500X
CO9927461041C0700X
CO9927891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty