Provider Demographics
NPI:1750121398
Name:TEEN CHALLENGE OF THE ROCKY MOUNTAINS INC
Entity type:Organization
Organization Name:TEEN CHALLENGE OF THE ROCKY MOUNTAINS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SELLAR
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, LAC
Authorized Official - Phone:303-744-3986
Mailing Address - Street 1:PO BOX 336
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80151-0336
Mailing Address - Country:US
Mailing Address - Phone:303-744-3986
Mailing Address - Fax:
Practice Address - Street 1:2634 S BROADWAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5705
Practice Address - Country:US
Practice Address - Phone:303-744-3986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEEN CHALLENGE OF THE ROCKY MOUNTAINS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-30
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health