Provider Demographics
NPI:1184064495
Name:BABCOCK, SAMUEL C (MA, LPC)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:C
Last Name:BABCOCK
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 77171
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80970-7171
Mailing Address - Country:US
Mailing Address - Phone:719-247-1350
Mailing Address - Fax:719-247-1350
Practice Address - Street 1:2502 W COLORADO AVE STE 201
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-3068
Practice Address - Country:US
Practice Address - Phone:719-247-1350
Practice Address - Fax:719-247-1350
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0012310101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional