Provider Demographics
NPI:1184035248
Name:COLORADO CENTER FOR COUNSELING AND PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:COLORADO CENTER FOR COUNSELING AND PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TAINEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CAC III
Authorized Official - Phone:303-776-6376
Mailing Address - Street 1:1479 LINCOLN CIR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-1879
Mailing Address - Country:US
Mailing Address - Phone:303-776-6376
Mailing Address - Fax:
Practice Address - Street 1:1479 LINCOLN CIR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-1879
Practice Address - Country:US
Practice Address - Phone:303-776-6376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty