Provider Demographics
NPI:1801396288
Name:TRAUMA RESOLUTION COLORADO
Entity Type:Organization
Organization Name:TRAUMA RESOLUTION COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:720-384-3498
Mailing Address - Street 1:8232 E 29TH PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-2723
Mailing Address - Country:US
Mailing Address - Phone:720-384-3498
Mailing Address - Fax:
Practice Address - Street 1:390 S POTOMAC WAY STE C
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-2491
Practice Address - Country:US
Practice Address - Phone:720-384-3498
Practice Address - Fax:303-321-1792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-13
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4569101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO66125081Medicaid