Healthcare Provider Details

I. General information

NPI: 1720704497
Provider Name (Legal Business Name): CREATING CONNECTIONS COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1250 S BUCKLEY RD
AURORA CO
80017-4180
US

IV. Provider business mailing address

1250 S BUCKLEY RD
AURORA CO
80017-4180
US

V. Phone/Fax

Practice location:
  • Phone: 719-582-4174
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MEDRANO
Title or Position: OWNER
Credential:
Phone: 719-582-4174