Provider Demographics
NPI:1780984641
Name:THERAPEUTIC CONSULTS, INC.
Entity type:Organization
Organization Name:THERAPEUTIC CONSULTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:KINNAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:719-331-5063
Mailing Address - Street 1:16832 BUFFALO VALLEY PATH
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-7172
Mailing Address - Country:US
Mailing Address - Phone:719-331-5063
Mailing Address - Fax:719-481-0304
Practice Address - Street 1:16832 BUFFALO VALLEY PATH
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-7172
Practice Address - Country:US
Practice Address - Phone:719-331-5063
Practice Address - Fax:719-481-0304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4334101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1073823050OtherNPI