Provider Demographics
NPI:1437910098
Name:LIONS GATE COUNSELING LLC
Entity Type:Organization
Organization Name:LIONS GATE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:303-217-1822
Mailing Address - Street 1:1975 19TH ST APT 4022
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-6076
Mailing Address - Country:US
Mailing Address - Phone:303-217-1822
Mailing Address - Fax:303-845-9065
Practice Address - Street 1:1975 19TH ST APT 4022
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-6076
Practice Address - Country:US
Practice Address - Phone:303-217-1822
Practice Address - Fax:303-845-9065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty