Provider Demographics
NPI: | 1265924864 |
---|---|
Name: | CONNEXUS SERVICES, LLC |
Entity type: | Organization |
Organization Name: | CONNEXUS SERVICES, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SCOTT |
Authorized Official - Middle Name: | DAVID |
Authorized Official - Last Name: | CLIFT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 303-523-8108 |
Mailing Address - Street 1: | 4155 E JEWELL AVE STE 712 |
Mailing Address - Street 2: | |
Mailing Address - City: | DENVER |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80222-4511 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 303-900-1916 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4155 E JEWELL AVE STE 712 |
Practice Address - Street 2: | |
Practice Address - City: | DENVER |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80222-4511 |
Practice Address - Country: | US |
Practice Address - Phone: | 303-900-1916 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-05-31 |
Last Update Date: | 2018-05-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CO | 0011395 | 101YP2500X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |