Provider Demographics
NPI:1851681555
Name:COUNSELING CENTER OF THE ROCKIES, LLC
Entity Type:Organization
Organization Name:COUNSELING CENTER OF THE ROCKIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:C
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:CACIII
Authorized Official - Phone:303-806-0933
Mailing Address - Street 1:4195 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-4794
Mailing Address - Country:US
Mailing Address - Phone:303-806-0933
Mailing Address - Fax:303-382-3959
Practice Address - Street 1:4195 S BROADWAY
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-4794
Practice Address - Country:US
Practice Address - Phone:303-806-0933
Practice Address - Fax:303-382-3959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1352-01251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health