Provider Demographics
NPI:1669419586
Name:COLORADO PARTNERS FOR CHANGE
Entity type:Organization
Organization Name:COLORADO PARTNERS FOR CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:GASKILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-634-3777
Mailing Address - Street 1:1330 QUAIL LAKE LOOP
Mailing Address - Street 2:STE. 240
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4651
Mailing Address - Country:US
Mailing Address - Phone:719-634-3777
Mailing Address - Fax:719-527-1101
Practice Address - Street 1:1330 QUAIL LAKE LOOP
Practice Address - Street 2:STE. 240
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4651
Practice Address - Country:US
Practice Address - Phone:719-634-3777
Practice Address - Fax:719-527-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO=========OtherTAX ID