Provider Demographics
NPI:1952921009
Name:WATERMARK COUNSELING
Entity Type:Organization
Organization Name:WATERMARK COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHOSHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:AAL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:720-514-9925
Mailing Address - Street 1:899 N LOGAN ST STE 307
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-3155
Mailing Address - Country:US
Mailing Address - Phone:720-514-9925
Mailing Address - Fax:888-494-4199
Practice Address - Street 1:899 N LOGAN ST STE 307
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-3155
Practice Address - Country:US
Practice Address - Phone:720-514-9925
Practice Address - Fax:888-494-4199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-18
Last Update Date:2020-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty