Provider Demographics
NPI:1639693450
Name:MENTAL HEALTH COUNSELING, PC
Entity Type:Organization
Organization Name:MENTAL HEALTH COUNSELING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERRON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:719-395-9454
Mailing Address - Street 1:34077 SURREY LN
Mailing Address - Street 2:
Mailing Address - City:BUENA VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81211-8813
Mailing Address - Country:US
Mailing Address - Phone:719-395-2765
Mailing Address - Fax:
Practice Address - Street 1:111 E. STERLING AVE
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:CO
Practice Address - Zip Code:81211-8121
Practice Address - Country:US
Practice Address - Phone:710-395-9454
Practice Address - Fax:719-395-9454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3804101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1447378997OtherINDIVIDUAL-MENTAL HEALTH COUNSELOR