Healthcare Provider Details

I. General information

NPI: 1669824512
Provider Name (Legal Business Name): VISTA COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2016
Last Update Date: 07/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 S BLACKHAWK ST
AURORA CO
80014-1487
US

IV. Provider business mailing address

2121 S BLACKHAWK ST
AURORA CO
80014-1487
US

V. Phone/Fax

Practice location:
  • Phone: 303-507-5825
  • Fax: 303-379-1740
Mailing address:
  • Phone: 303-507-5825
  • Fax: 303-379-1740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0000497
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09924397
License Number StateCO

VIII. Authorized Official

Name: JEANETTE BARICH
Title or Position: OWNER
Credential: LCSW, LAC
Phone: 303-507-5825