Provider Demographics
NPI:1912590654
Name:AESTHETICS COUNSELING, PLLC
Entity Type:Organization
Organization Name:AESTHETICS COUNSELING, PLLC
Other - Org Name:TINA M REYERO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CLINICAL MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:REYERO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:720-937-7190
Mailing Address - Street 1:2514 W COLORADO AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-3074
Mailing Address - Country:US
Mailing Address - Phone:720-937-7190
Mailing Address - Fax:
Practice Address - Street 1:2532 W COLORADO AVE STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-3023
Practice Address - Country:US
Practice Address - Phone:720-937-7190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-13
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1912590654Medicaid