Provider Demographics
NPI:1750628913
Name:COLORADO FAMILY CENTER, PLCC
Entity Type:Organization
Organization Name:COLORADO FAMILY CENTER, PLCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:FRYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-794-7761
Mailing Address - Street 1:11 W DRY CREEK CIR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-8077
Mailing Address - Country:US
Mailing Address - Phone:303-794-7761
Mailing Address - Fax:303-794-7811
Practice Address - Street 1:11 W DRY CREEK CIR
Practice Address - Street 2:SUITE 140
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-8077
Practice Address - Country:US
Practice Address - Phone:303-794-7761
Practice Address - Fax:303-794-7811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C-J0006Medicare PIN