Provider Demographics
NPI:1245784933
Name:TIKKUN COUNSELING GROUP, LLC
Entity Type:Organization
Organization Name:TIKKUN COUNSELING GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:MARCELA
Authorized Official - Last Name:SANTA BERRIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-845-5339
Mailing Address - Street 1:2181 S TRENTON WAY
Mailing Address - Street 2:14-204
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-5393
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3339 W 38TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-1909
Practice Address - Country:US
Practice Address - Phone:303-455-3767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty