Provider Demographics
NPI:1689823668
Name:PSYCHOTHERAPY AND CARE MANAGEMENT ON THE GO, LLC
Entity Type:Organization
Organization Name:PSYCHOTHERAPY AND CARE MANAGEMENT ON THE GO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEANN
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:303-204-6635
Mailing Address - Street 1:12954 W ILIFF AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-4336
Mailing Address - Country:US
Mailing Address - Phone:303-204-6635
Mailing Address - Fax:303-504-6410
Practice Address - Street 1:12954 W ILIFF AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-4336
Practice Address - Country:US
Practice Address - Phone:303-204-6635
Practice Address - Fax:303-504-6410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9925581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty