Provider Demographics
NPI:1710013073
Name:COMMUNITY REACH CENTER
Entity Type:Organization
Organization Name:COMMUNITY REACH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGAM MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACELL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-853-3697
Mailing Address - Street 1:13293 NIWOT TRL
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-5580
Mailing Address - Country:US
Mailing Address - Phone:202-543-3894
Mailing Address - Fax:
Practice Address - Street 1:8989 HURON ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80260-6858
Practice Address - Country:US
Practice Address - Phone:303-853-3697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLMFT 502106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty