Provider Demographics
NPI:1760922884
Name:ASCENSION COUNSELING & TRANSFORMATION
Entity Type:Organization
Organization Name:ASCENSION COUNSELING & TRANSFORMATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER/ CO-DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, PSYCOTHERAPIST
Authorized Official - Phone:719-589-6438
Mailing Address - Street 1:811 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2541
Mailing Address - Country:US
Mailing Address - Phone:719-589-6438
Mailing Address - Fax:719-589-6438
Practice Address - Street 1:811 MAIN ST
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2541
Practice Address - Country:US
Practice Address - Phone:719-589-6438
Practice Address - Fax:719-589-6438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1653-00251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health