Provider Demographics
NPI:1932261617
Name:CANON CITY COUNSELING & PSYCHOTHERAPY SERVICES
Entity Type:Organization
Organization Name:CANON CITY COUNSELING & PSYCHOTHERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LCSW
Authorized Official - Phone:719-275-4442
Mailing Address - Street 1:109 LATIGO LN
Mailing Address - Street 2:SUITE E-2
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-8112
Mailing Address - Country:US
Mailing Address - Phone:719-275-4442
Mailing Address - Fax:719-275-4442
Practice Address - Street 1:109 LATIGO LN
Practice Address - Street 2:SUITE E-2
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-8112
Practice Address - Country:US
Practice Address - Phone:719-275-4442
Practice Address - Fax:719-275-4442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9922711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO992271OtherLCSW LICENSE NUMBER