Provider Demographics
NPI:1487025409
Name:COLORADO SOUL CARE, LLC
Entity Type:Organization
Organization Name:COLORADO SOUL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MARRIAGE & FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LEE ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHADRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MFTC
Authorized Official - Phone:937-409-4203
Mailing Address - Street 1:24562 E EASTER PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-4105
Mailing Address - Country:US
Mailing Address - Phone:937-409-4203
Mailing Address - Fax:
Practice Address - Street 1:5650 GREENWOOD PLAZA BLVD
Practice Address - Street 2:#202
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2307
Practice Address - Country:US
Practice Address - Phone:937-409-4203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13541106H00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty