Provider Demographics
NPI:1720208119
Name:IDEA FORUM INC
Entity Type:Organization
Organization Name:IDEA FORUM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAIZ
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CACIII
Authorized Official - Phone:303-477-8280
Mailing Address - Street 1:2560 W 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-3712
Mailing Address - Country:US
Mailing Address - Phone:303-477-8280
Mailing Address - Fax:303-477-1369
Practice Address - Street 1:2560 W 29TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-3712
Practice Address - Country:US
Practice Address - Phone:303-477-8280
Practice Address - Fax:303-477-1369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1322101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty