MEDICARE: CHILD AND ADOLESCENT COUNSELING OF DENVER PLLC

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1861180614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILD AND ADOLESCENT COUNSELING OF DENVER PLLC

Provider Business Mailing Address
First Line	:	6087 S QUEBEC ST STE 102
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80111-4539
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6087 S QUEBEC ST STE 102
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80111-4539
Country	:	US
Telephone Number	:	303-835-6992
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARY ELLEN HUDSON
Credential	:
Telephone Number	:	699-230-3835

Provider Enumeration Date	:	04/28/2023
Last Update Date	:	04/28/2023

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