Provider Demographics
NPI:1154866069
Name:CONIFER FAMILY THERAPY, LLC
Entity Type:Organization
Organization Name:CONIFER FAMILY THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:Q
Authorized Official - Last Name:PALAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LMFT, CAC III
Authorized Official - Phone:303-990-2696
Mailing Address - Street 1:26689 PLEASANT PARK RD STE 70
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-7741
Mailing Address - Country:US
Mailing Address - Phone:303-990-2696
Mailing Address - Fax:303-302-0850
Practice Address - Street 1:26689 PLEASANT PARK RD STE 70
Practice Address - Street 2:
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-7741
Practice Address - Country:US
Practice Address - Phone:303-990-2696
Practice Address - Fax:303-302-0850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-31
Last Update Date:2016-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty