Provider Demographics
NPI:1760950232
Name:SPECIALIZED COUNSELING COLORADO
Entity Type:Organization
Organization Name:SPECIALIZED COUNSELING COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RUNGE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:720-909-9910
Mailing Address - Street 1:13135 W 2ND PL APT D3532
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1472
Mailing Address - Country:US
Mailing Address - Phone:720-909-9910
Mailing Address - Fax:
Practice Address - Street 1:13701 W JEWELL AVE # 200-6
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-4139
Practice Address - Country:US
Practice Address - Phone:720-909-9910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-02
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty