Provider Demographics
NPI:1013524297
Name:BY YOUR SIDE COLORADO, LLC
Entity Type:Organization
Organization Name:BY YOUR SIDE COLORADO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR MANAGER-BILLING
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOZICKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-590-5571
Mailing Address - Street 1:8201 CASS AVE
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-5314
Mailing Address - Country:US
Mailing Address - Phone:630-590-5571
Mailing Address - Fax:
Practice Address - Street 1:8415 EXPLORER DR STE 130
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1034
Practice Address - Country:US
Practice Address - Phone:630-590-5571
Practice Address - Fax:630-326-7175
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BY YOUR SIDE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-30
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty