Provider Demographics
NPI:1356002950
Name:OUR VILLAGE COUNSELING
Entity Type:Organization
Organization Name:OUR VILLAGE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC,RPT
Authorized Official - Phone:970-658-7121
Mailing Address - Street 1:2627 REDWING RD STE 235
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-6352
Mailing Address - Country:US
Mailing Address - Phone:970-658-7121
Mailing Address - Fax:
Practice Address - Street 1:2627 REDWING RD STE 235
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-6352
Practice Address - Country:US
Practice Address - Phone:970-658-7121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-05
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty