Provider Demographics
NPI:1700027828
Name:CONNEXUS COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:CONNEXUS COUNSELING CENTER, LLC
Other - Org Name:CONNEXUS SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:CLIFT
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:303-523-8108
Mailing Address - Street 1:4155 E JEWELL AVE
Mailing Address - Street 2:712
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4504
Mailing Address - Country:US
Mailing Address - Phone:303-523-8108
Mailing Address - Fax:720-230-4906
Practice Address - Street 1:9255 W ALAMEDA AVE
Practice Address - Street 2:UNIT E
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-2802
Practice Address - Country:US
Practice Address - Phone:303-523-8108
Practice Address - Fax:303-558-3807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0011395101YP2500X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1659524809OtherNATIONAL PROVIDER IDENTIFIER (SOLE PROPRIETOR)