Provider Demographics
NPI:1598357261
Name:CHILD AND FAMILY GUIDANCE AND SUPPORT CENTER
Entity Type:Organization
Organization Name:CHILD AND FAMILY GUIDANCE AND SUPPORT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:COUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:720-381-2543
Mailing Address - Street 1:114 N BOULEVARD ST STE 203
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-3011
Mailing Address - Country:US
Mailing Address - Phone:720-381-2543
Mailing Address - Fax:
Practice Address - Street 1:114 N BOULEVARD ST STE 203
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-3011
Practice Address - Country:US
Practice Address - Phone:720-381-2543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1881931392.OtherKRISTIN COUGHLIN