Provider Demographics
NPI:1417335035
Name:IN THE MOMENT COUNSELING, LLC
Entity Type:Organization
Organization Name:IN THE MOMENT COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEDTKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:720-295-1199
Mailing Address - Street 1:201 S WILCOX ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-3315
Mailing Address - Country:US
Mailing Address - Phone:720-295-1199
Mailing Address - Fax:720-634-0646
Practice Address - Street 1:201 S WILCOX ST
Practice Address - Street 2:SUITE 202
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-3315
Practice Address - Country:US
Practice Address - Phone:720-295-1199
Practice Address - Fax:720-634-0646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9928711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty