Provider Demographics
NPI:1720603475
Name:ACHIEVE WELLNESS COUNSELING AND CONSULTING, LLC
Entity Type:Organization
Organization Name:ACHIEVE WELLNESS COUNSELING AND CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:T
Authorized Official - Last Name:BASLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:719-627-3233
Mailing Address - Street 1:9362 GRAND CORDERA PARKWAY STE 170
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924
Mailing Address - Country:US
Mailing Address - Phone:719-627-3233
Mailing Address - Fax:
Practice Address - Street 1:9362 GRAND CORDERA PARKWAY STE 170
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924
Practice Address - Country:US
Practice Address - Phone:719-627-3233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-09
Last Update Date:2021-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1689299315OtherNPPES
COCSW.00001092OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES (DORA)