Provider Demographics
NPI:1477006450
Name:MANTIS COUNSELING AND COACHING SERVICES
Entity Type:Organization
Organization Name:MANTIS COUNSELING AND COACHING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINGEWATT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:720-394-1437
Mailing Address - Street 1:1544 YORK ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1442
Mailing Address - Country:US
Mailing Address - Phone:720-394-1437
Mailing Address - Fax:
Practice Address - Street 1:1544 YORK ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1442
Practice Address - Country:US
Practice Address - Phone:720-394-1437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4686101YP2500X
CO4768101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1336348325OtherPERSONAL NPI
CO65077504Medicaid
CO1750579249OtherPERSONAL NPI