Provider Demographics
NPI:1770923229
Name:CHIPITA COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:CHIPITA COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:K
Authorized Official - Last Name:LONGWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:719-329-4810
Mailing Address - Street 1:1548 G ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-2645
Mailing Address - Country:US
Mailing Address - Phone:719-329-4810
Mailing Address - Fax:866-805-1874
Practice Address - Street 1:1548 G ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2645
Practice Address - Country:US
Practice Address - Phone:719-329-4810
Practice Address - Fax:866-805-1874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA 103565OtherMEDICARE PROVIDER TRANSACTION ACCESS NUMBER
CO69200084Medicaid