Provider Demographics
NPI:1477700565
Name:CANON CITY COUNSELING, INC
Entity Type:Organization
Organization Name:CANON CITY COUNSELING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:719-276-0292
Mailing Address - Street 1:224 N COTTONWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-2507
Mailing Address - Country:US
Mailing Address - Phone:719-276-0292
Mailing Address - Fax:719-276-0292
Practice Address - Street 1:224 N COTTONWOOD AVE
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-2507
Practice Address - Country:US
Practice Address - Phone:719-276-0292
Practice Address - Fax:719-276-0292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5044101YA0400X
CO6391101YA0400X
CO2425101YP2500X
CO3037101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty