Provider Demographics
NPI:1134897218
Name:COORDINATED COUNSELING FOR CHILDREN
Entity type:Organization
Organization Name:COORDINATED COUNSELING FOR CHILDREN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:JASMINE
Authorized Official - Last Name:WISDOM-IMBACH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC
Authorized Official - Phone:303-946-9071
Mailing Address - Street 1:1551 LARIMER ST APT 2406
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1637
Mailing Address - Country:US
Mailing Address - Phone:303-946-9071
Mailing Address - Fax:267-288-0775
Practice Address - Street 1:6795 E TENNESSEE AVE # 1-413
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-1614
Practice Address - Country:US
Practice Address - Phone:503-450-9900
Practice Address - Fax:267-288-0775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-02
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty