Provider Demographics
NPI:1851530562
Name:COLUMBINE COUNSELING CENTER
Entity Type:Organization
Organization Name:COLUMBINE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JACK
Authorized Official - Last Name:POOL
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:209-586-6868
Mailing Address - Street 1:PO BOX 1477
Mailing Address - Street 2:
Mailing Address - City:TWAIN HARTE
Mailing Address - State:CA
Mailing Address - Zip Code:95383-1477
Mailing Address - Country:US
Mailing Address - Phone:209-586-6868
Mailing Address - Fax:
Practice Address - Street 1:22984 TWAIN HARTE DRIVE
Practice Address - Street 2:
Practice Address - City:TWAIN HARTE
Practice Address - State:CA
Practice Address - Zip Code:95383
Practice Address - Country:US
Practice Address - Phone:209-586-6868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT30749251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health