MEDICARE: CATHOLIC CHARITIES AND COMMUNITY SERVICES OF THE ARCHDIOCESE OF DENVER

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	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1770391088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATHOLIC CHARITIES AND COMMUNITY SERVICES OF THE ARCHDIOCESE OF DENVER

Provider Business Mailing Address
First Line	:	6240 SMITH RD
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80216-4632
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	460 LINDEN CENTER DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-2460
Country	:	US
Telephone Number	:	970-484-5010
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECOTR
Name	:	STACEY HOFFMAN HIATT
Credential	:	LCSW
Telephone Number	:	720-998-6276

Provider Enumeration Date	:	12/19/2024
Last Update Date	:	12/19/2024

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