Provider Demographics
NPI:1619605532
Name:REAL TALK COUNSELING FROM AN URBAN PERSPECTIVE
Entity Type:Organization
Organization Name:REAL TALK COUNSELING FROM AN URBAN PERSPECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAWAUNE
Authorized Official - Middle Name:LATIETH
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:303-377-0370
Mailing Address - Street 1:2323 S TROY ST STE 5-209
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1900
Mailing Address - Country:US
Mailing Address - Phone:303-377-0370
Mailing Address - Fax:
Practice Address - Street 1:2323 S TROY ST STE 5-209
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1900
Practice Address - Country:US
Practice Address - Phone:303-377-0370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO2438-01OtherOBH COLORADO LICENSE