Provider Demographics
NPI:1740623560
Name:ST. RAPHAEL COUNSELING, LLC
Entity type:Organization
Organization Name:ST. RAPHAEL COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:CRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, NCC
Authorized Official - Phone:970-310-5132
Mailing Address - Street 1:1115 GRANT ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-2369
Mailing Address - Country:US
Mailing Address - Phone:720-675-7796
Mailing Address - Fax:
Practice Address - Street 1:1115 GRANT ST
Practice Address - Street 2:SUITE 305
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-2369
Practice Address - Country:US
Practice Address - Phone:720-675-7796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3752103TA0400X, 103TB0200X, 103TC0700X, 103TC1900X, 103TC2200X, 103TF0000X, 103TM1800X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty