Provider Demographics
NPI:1902414238
Name:COLORADO TEEN AND FAMILY CENTER
Entity Type:Organization
Organization Name:COLORADO TEEN AND FAMILY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:THOMPSON TEXIDOR
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:720-808-0139
Mailing Address - Street 1:1776 S JACKSON ST STE 530
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3851
Mailing Address - Country:US
Mailing Address - Phone:720-808-0139
Mailing Address - Fax:
Practice Address - Street 1:1776 S JACKSON ST STE 530
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3851
Practice Address - Country:US
Practice Address - Phone:720-808-0139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)