Provider Demographics
NPI:1154847267
Name:CONNECTIVITY COUNSELING, LLC.
Entity Type:Organization
Organization Name:CONNECTIVITY COUNSELING, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:DURHAM
Authorized Official - Last Name:FLOYDE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:719-717-9009
Mailing Address - Street 1:PO BOX 1214
Mailing Address - Street 2:
Mailing Address - City:PONCHA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81242-1001
Mailing Address - Country:US
Mailing Address - Phone:719-717-9009
Mailing Address - Fax:
Practice Address - Street 1:123 G ST STE 8
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2030
Practice Address - Country:US
Practice Address - Phone:719-717-9009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099240051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty