Provider Demographics
NPI:1629337548
Name:MIKE HARRIS COUNSELING GROUP, P.C.
Entity Type:Organization
Organization Name:MIKE HARRIS COUNSELING GROUP, P.C.
Other - Org Name:CREST COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, LAC
Authorized Official - Phone:303-246-7135
Mailing Address - Street 1:448 E 1ST ST
Mailing Address - Street 2:SUITE 226
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-2804
Mailing Address - Country:US
Mailing Address - Phone:719-207-4163
Mailing Address - Fax:719-745-7000
Practice Address - Street 1:448 E 1ST ST
Practice Address - Street 2:SUITE 226
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2804
Practice Address - Country:US
Practice Address - Phone:719-207-4163
Practice Address - Fax:719-745-7000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-12
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO221101YA0400X
CO8052101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO20781873Medicaid