Provider Demographics
NPI:1306004585
Name:EAGLE VALLEY COUNSELING LLC
Entity Type:Organization
Organization Name:EAGLE VALLEY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GAHAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CACIII, ADVP
Authorized Official - Phone:970-926-8196
Mailing Address - Street 1:275 MAIN ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-7805
Mailing Address - Country:US
Mailing Address - Phone:970-926-8196
Mailing Address - Fax:970-926-8438
Practice Address - Street 1:275 MAIN ST
Practice Address - Street 2:SUITE 208
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-7805
Practice Address - Country:US
Practice Address - Phone:970-926-8196
Practice Address - Fax:970-926-8438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-24
Last Update Date:2008-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1803251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health