Provider Demographics
NPI:1457061186
Name:SOMATIC COUNSELING SERVICES PLLC
Entity Type:Organization
Organization Name:SOMATIC COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHAVONE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRESPO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:347-819-2162
Mailing Address - Street 1:2301 BLAKE ST STE 267
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-2101
Mailing Address - Country:US
Mailing Address - Phone:347-819-2162
Mailing Address - Fax:
Practice Address - Street 1:2301 BLAKE ST STE 267
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-2101
Practice Address - Country:US
Practice Address - Phone:347-819-2162
Practice Address - Fax:720-473-7810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)