Provider Demographics
NPI:1750746350
Name:COLORADO INSTITUTE FOR CONTEMPORARY PSYCHOTHERAPY PLLC
Entity type:Organization
Organization Name:COLORADO INSTITUTE FOR CONTEMPORARY PSYCHOTHERAPY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOROZOV
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW
Authorized Official - Phone:303-264-7946
Mailing Address - Street 1:6795 E TENNESSEE AVE STE 432
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-1659
Mailing Address - Country:US
Mailing Address - Phone:303-264-7946
Mailing Address - Fax:303-474-9460
Practice Address - Street 1:6795 E TENNESSEE AVE STE 432
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-1659
Practice Address - Country:US
Practice Address - Phone:303-264-7946
Practice Address - Fax:303-474-9460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099241071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO023110379OtherCOLORADO DRIVER LICENSE