Healthcare Provider Details

I. General information

NPI: 1053508986
Provider Name (Legal Business Name): FAMILY LIFE COUNSELING, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6240 S MAIN ST SUITE #265
AURORA CO
80016-5376
US

IV. Provider business mailing address

6240 S MAIN ST SUITE #265
AURORA CO
80016-5376
US

V. Phone/Fax

Practice location:
  • Phone: 720-274-5270
  • Fax: 720-274-5267
Mailing address:
  • Phone: 720-274-5270
  • Fax: 720-274-5267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2235
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number992746
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number992789
License Number StateCO

VIII. Authorized Official

Name: MR. KEVIN J. DYK
Title or Position: PRESIDENT
Credential: L.P.C.
Phone: 720-274-5270