Provider Demographics
NPI:1679915094
Name:HAUSE COUNSELING BIOFEEDBACK LLC
Entity Type:Organization
Organization Name:HAUSE COUNSELING BIOFEEDBACK LLC
Other - Org Name:PAIN FITNESS FUNDAMENTALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC BCB
Authorized Official - Phone:303-995-2935
Mailing Address - Street 1:2250 S ONEIDA ST
Mailing Address - Street 2:206
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-2556
Mailing Address - Country:US
Mailing Address - Phone:303-995-2935
Mailing Address - Fax:720-493-5952
Practice Address - Street 1:2250 S ONEIDA ST
Practice Address - Street 2:206
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-2556
Practice Address - Country:US
Practice Address - Phone:303-995-2935
Practice Address - Fax:720-493-5952
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAUSE COUNSELING BIOFEEDBACK LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-26
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3018101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty