Provider Demographics
NPI:1245626787
Name:COLORADO RELATIONSHIP RECOVERY LLC
Entity type:Organization
Organization Name:COLORADO RELATIONSHIP RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:POLK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LAC
Authorized Official - Phone:720-272-9573
Mailing Address - Street 1:6541 S TABOR ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-4854
Mailing Address - Country:US
Mailing Address - Phone:720-272-9573
Mailing Address - Fax:
Practice Address - Street 1:1777 S BELLAIRE ST STE 165
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4310
Practice Address - Country:US
Practice Address - Phone:303-217-2658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-10
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0000426251S00000X
1041C0700X
COCSW.09923905251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty