Healthcare Provider Details

I. General information

NPI: 1144983305
Provider Name (Legal Business Name): ASCENSION COUNSELING & TRANSFORMATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2021
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 MAIN ST
ALAMOSA CO
81101-2541
US

IV. Provider business mailing address

811 MAIN ST
ALAMOSA CO
81101-2541
US

V. Phone/Fax

Practice location:
  • Phone: 719-589-6438
  • Fax: 719-589-2668
Mailing address:
  • Phone: 719-589-6438
  • Fax: 719-589-2668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SANDRA GOODWIN
Title or Position: OWNER
Credential:
Phone: 719-589-6438