MEDICARE: INSIDE OUT COUNSELING PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	991618	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447475280
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSIDE OUT COUNSELING PC

Provider Business Mailing Address
First Line	:	PO BOX 7567
Second Line	:
City	:	PUEBLO WEST
State	:	CO
Zip	:	81007-0567
Country	:	US
Telephone Number	:	719-250-9569
Fax Number	:	719-547-7869

Provider Business Practice Location Address
First Line	:	44 E SPAULDING AVE
Second Line	:	BUILDING 3, SUITE 1
City	:	PUEBLO WEST
State	:	CO
Zip	:	81007-1668
Country	:	US
Telephone Number	:	719-250-9569
Fax Number	:	719-547-7869

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	DR. JOHN R DENGLER
Credential	:	LCSW, PHD
Telephone Number	:	717-250-9569

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	02/10/2017

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