Provider Demographics
NPI:1740854504
Name:CREEKSIDE COLLABORATIVE THERAPY
Entity type:Organization
Organization Name:CREEKSIDE COLLABORATIVE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:LEFCO-ROCKEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:720-504-7763
Mailing Address - Street 1:6000 GREENWOOD PLAZA BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4818
Mailing Address - Country:US
Mailing Address - Phone:303-770-6933
Mailing Address - Fax:
Practice Address - Street 1:8420 S CONTINENTAL DIVIDE RD STE 224
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-4251
Practice Address - Country:US
Practice Address - Phone:303-770-6933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-17
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty