Provider Demographics
NPI:1639413248
Name:CENTRO DE LA FAMILIA
Entity Type:Organization
Organization Name:CENTRO DE LA FAMILIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LUCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:719-238-8638
Mailing Address - Street 1:PO BOX 15005
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80935-5005
Mailing Address - Country:US
Mailing Address - Phone:719-238-8638
Mailing Address - Fax:719-227-9185
Practice Address - Street 1:1645 S MURRAY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80916-4502
Practice Address - Country:US
Practice Address - Phone:719-238-8638
Practice Address - Fax:719-227-9185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW-991418101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO007528Medicaid