Provider Demographics
NPI:1497223234
Name:INTERMOUNTAIN COUNSELING
Entity Type:Organization
Organization Name:INTERMOUNTAIN COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:719-357-6031
Mailing Address - Street 1:6311 ALTMAN DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3203
Mailing Address - Country:US
Mailing Address - Phone:719-332-6687
Mailing Address - Fax:
Practice Address - Street 1:6180 LEHMAN DR STE 205
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3459
Practice Address - Country:US
Practice Address - Phone:719-332-6687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-09
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty