Provider Demographics
NPI:1942699335
Name:RUNNING STREAM COUNSELING SERVICE, PC
Entity Type:Organization
Organization Name:RUNNING STREAM COUNSELING SERVICE, PC
Other - Org Name:RUNNING CREEK COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:303-805-1218
Mailing Address - Street 1:18425 PONY EXPRESS DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-9605
Mailing Address - Country:US
Mailing Address - Phone:303-805-1218
Mailing Address - Fax:303-805-3679
Practice Address - Street 1:421 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3196
Practice Address - Country:US
Practice Address - Phone:719-214-3033
Practice Address - Fax:719-544-1186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC.0001544101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02656027Medicaid