MEDICARE: COLORADO CHRISTIAN UNIVERSITY COMMUNITY COUNSELING CENTER

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

General Provider Information

NPI Number	:	1992329189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO CHRISTIAN UNIVERSITY COMMUNITY COUNSELING CENTER

Provider Business Mailing Address
First Line	:	1125 KELLY JOHNSON BLVD STE 105
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3930
Country	:	US
Telephone Number	:	719-867-5805
Fax Number	:

Provider Business Practice Location Address
First Line	:	1125 KELLY JOHNSON BLVD STE 105
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3930
Country	:	US
Telephone Number	:	719-867-5805
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	DR. TRENTON DALE LANGHOFER
Credential	:	PHD
Telephone Number	:	316-992-3062

Provider Enumeration Date	:	06/03/2020
Last Update Date	:	12/15/2025

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