Provider Demographics
NPI:1689033342
Name:CENTER FOR ETHICAL SOCIAL WORK PRACTICE
Entity Type:Organization
Organization Name:CENTER FOR ETHICAL SOCIAL WORK PRACTICE
Other - Org Name:PETAL & PEAK MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:J
Authorized Official - Last Name:RAAB
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:720-722-0527
Mailing Address - Street 1:5353 W DARTMOUTH AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80227-5517
Mailing Address - Country:US
Mailing Address - Phone:720-722-0527
Mailing Address - Fax:
Practice Address - Street 1:5353 W DARTMOUTH AVE STE 203
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80227-5516
Practice Address - Country:US
Practice Address - Phone:720-722-0527
Practice Address - Fax:303-586-1196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW 1534261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health