MEDICARE: COLLABORATE COUNSELING LLC

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	106H00000X	Marriage & Family Therapist	MFT.0001460	CO

General Provider Information

NPI Number	:	1992296057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLABORATE COUNSELING LLC

Provider Business Mailing Address
First Line	:	6133 S GENEVA WAY
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80111-5439
Country	:	US
Telephone Number	:	720-323-2603
Fax Number	:

Provider Business Practice Location Address
First Line	:	6075 S QUEBEC ST STE 203
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80111-4535
Country	:	US
Telephone Number	:	720-708-4865
Fax Number	:	303-993-8899

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	CAROLYN SUE RIVIERE-PLACZEK
Credential	:	LMFT
Telephone Number	:	720-323-2603

Provider Enumeration Date	:	05/24/2018
Last Update Date	:	05/24/2018

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