MEDICARE: CLINICA COUNSELING

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	251S00000X	Community/Behavioral Health Agency		CO

General Provider Information

NPI Number	:	1740658939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICA COUNSELING

Provider Business Mailing Address
First Line	:	8380 ZUNI ST
Second Line	:	UNIT 205
City	:	DENVER
State	:	CO
Zip	:	80221-4778
Country	:	US
Telephone Number	:	303-823-1988
Fax Number	:

Provider Business Practice Location Address
First Line	:	8380 ZUNI ST
Second Line	:	SUITE 205
City	:	DENVER
State	:	CO
Zip	:	80221-4778
Country	:	US
Telephone Number	:	303-823-1988
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MR. RICARDO BANUELOS
Credential	:	MA, LPC, CAC III
Telephone Number	:	303-823-1988

Provider Enumeration Date	:	09/04/2015
Last Update Date	:	03/23/2016

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