Provider Demographics
NPI:1417144700
Name:BONNIE MUCKLOW
Entity Type:Organization
Organization Name:BONNIE MUCKLOW
Other - Org Name:FAMILIES AT FIVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUCKLOW
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:720-898-8711
Mailing Address - Street 1:1191 S PARKER RD
Mailing Address - Street 2:STE 100
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80234
Mailing Address - Country:US
Mailing Address - Phone:720-488-3822
Mailing Address - Fax:303-798-3883
Practice Address - Street 1:1191 S PARKER RD
Practice Address - Street 2:STE 100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80234
Practice Address - Country:US
Practice Address - Phone:720-488-3822
Practice Address - Fax:303-798-3883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO980101YA0400X
CO116101YP2500X
CO149106H00000X
CO114251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty