Provider Demographics
NPI:1861856882
Name:FOUR FEATHERS COUNSELING CORPORATION
Entity Type:Organization
Organization Name:FOUR FEATHERS COUNSELING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESITA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TIRONA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:719-761-1655
Mailing Address - Street 1:1225 WOODLAND VALLEY RANCH DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-7409
Mailing Address - Country:US
Mailing Address - Phone:719-761-1655
Mailing Address - Fax:855-332-4436
Practice Address - Street 1:321 W HENRIETTA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-3145
Practice Address - Country:US
Practice Address - Phone:719-761-1655
Practice Address - Fax:855-332-4436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4470101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO25452266Medicaid