Provider Demographics
NPI:1598308181
Name:AUTHENTIC LIFE COUNSELING COLORADO SPRINGS
Entity Type:Organization
Organization Name:AUTHENTIC LIFE COUNSELING COLORADO SPRINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:ERITANO RICHEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, LAC
Authorized Official - Phone:719-963-2927
Mailing Address - Street 1:PO BOX 64002
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80962-4002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1115 ELKTON DR STE 202
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-3599
Practice Address - Country:US
Practice Address - Phone:719-963-2927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)