Provider Demographics
NPI:1235820838
Name:TABULA RASA COUNSELING, PLLC
Entity Type:Organization
Organization Name:TABULA RASA COUNSELING, PLLC
Other - Org Name:TABULA RASA, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CLINICAL DIRECTOR/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CARA
Authorized Official - Middle Name:FAITH
Authorized Official - Last Name:CZARNECKI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:630-670-0281
Mailing Address - Street 1:2875 S XANADU WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-3447
Mailing Address - Country:US
Mailing Address - Phone:630-670-0281
Mailing Address - Fax:
Practice Address - Street 1:1777 S HARRISON ST STE 1200
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3955
Practice Address - Country:US
Practice Address - Phone:630-670-0281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty