Provider Demographics
NPI:1821422379
Name:CREEKSIDE COLLABORATIVE THERAPY
Entity Type:Organization
Organization Name:CREEKSIDE COLLABORATIVE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEFCO-ROCKEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:303-770-6933
Mailing Address - Street 1:6000 GREENWOOD PLAZA BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4818
Mailing Address - Country:US
Mailing Address - Phone:303-770-6933
Mailing Address - Fax:303-586-6075
Practice Address - Street 1:6000 GREENWOOD PLAZA BLVD STE 105
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-4818
Practice Address - Country:US
Practice Address - Phone:303-770-6933
Practice Address - Fax:303-586-6075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-01
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9926001041C0700X
CO9928301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty