Provider Demographics
NPI:1932617792
Name:WHOLE KIDS CO. PLLC
Entity Type:Organization
Organization Name:WHOLE KIDS CO. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, BCBA
Authorized Official - Phone:469-223-1579
Mailing Address - Street 1:11681 VOYAGER PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-3864
Mailing Address - Country:US
Mailing Address - Phone:719-344-9342
Mailing Address - Fax:719-375-3531
Practice Address - Street 1:11681 VOYAGER PKWY STE 150
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-3864
Practice Address - Country:US
Practice Address - Phone:719-344-9342
Practice Address - Fax:719-375-3531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-15
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013986101YP2500X
CO1-16-22433103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO00684210Medicaid