Provider Demographics
NPI:1467998351
Name:LA CLINICA DE ESPERANZA, LLC (PRIVATE PRACTICE)
Entity Type:Organization
Organization Name:LA CLINICA DE ESPERANZA, LLC (PRIVATE PRACTICE)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GUNZNER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MA, LMFT, CACII
Authorized Official - Phone:720-280-7063
Mailing Address - Street 1:830 KIPLING ST
Mailing Address - Street 2:SUITE #201
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-5899
Mailing Address - Country:US
Mailing Address - Phone:720-280-7063
Mailing Address - Fax:720-981-2871
Practice Address - Street 1:830 KIPLING ST
Practice Address - Street 2:SUITE #201
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-5899
Practice Address - Country:US
Practice Address - Phone:720-280-7063
Practice Address - Fax:720-981-2871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACB.0007312101YA0400X
COMFT.0001284106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty