Provider Demographics
NPI:1982114773
Name:STONE BRIDGE COUNSELING CENTER, INC.
Entity Type:Organization
Organization Name:STONE BRIDGE COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:719-203-7442
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-0054
Mailing Address - Country:US
Mailing Address - Phone:719-203-7442
Mailing Address - Fax:719-325-7075
Practice Address - Street 1:3225 TEMPLETON GAP RD STE 203
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8714
Practice Address - Country:US
Practice Address - Phone:719-203-7442
Practice Address - Fax:719-325-7075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-05
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0013770101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty