Provider Demographics
NPI:1619300720
Name:DYNAMIC DIRECTIONS COUNSELING INC
Entity Type:Organization
Organization Name:DYNAMIC DIRECTIONS COUNSELING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:PUTNOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-257-6715
Mailing Address - Street 1:7000 S BROADWAY STE 1A
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-1064
Mailing Address - Country:US
Mailing Address - Phone:303-797-1440
Mailing Address - Fax:
Practice Address - Street 1:7000 S BROADWAY STE 1A
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-1064
Practice Address - Country:US
Practice Address - Phone:303-797-1440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1667-01261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health