Provider Demographics
NPI:1518592146
Name:COMMUNITY COUNSELING AND CONSULTING SERVICES
Entity Type:Organization
Organization Name:COMMUNITY COUNSELING AND CONSULTING SERVICES
Other - Org Name:LIFE RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ALEJANDRO
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LAC
Authorized Official - Phone:303-667-3154
Mailing Address - Street 1:10699 MELODY DR STE 2
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234-4131
Mailing Address - Country:US
Mailing Address - Phone:303-252-4179
Mailing Address - Fax:303-252-4186
Practice Address - Street 1:2425 S COLORADO BLVD STE 150
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-5943
Practice Address - Country:US
Practice Address - Phone:720-398-9280
Practice Address - Fax:720-440-9638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-04
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000181296Medicaid
CO1528-05OtherDEPT. OF HUMAN SERVICES OFFICE OF BEHAVIORAL HEALTH
CO1528-05OtherOBH
CO900173170313Medicaid