Healthcare Provider Details

I. General information

NPI: 1417265950
Provider Name (Legal Business Name): EMINENCE COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2010
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11111 E. MISSISSIPPI AVE SUITE 200
AURORA CO
80012-4239
US

IV. Provider business mailing address

11111 E. MISSISSIPPI AVE SUITE 200
AURORA CO
80012-4239
US

V. Phone/Fax

Practice location:
  • Phone: 303-296-2350
  • Fax: 303-296-2450
Mailing address:
  • Phone: 303-296-2350
  • Fax: 303-296-2450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1663-00
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number1663-00
License Number StateCO

VIII. Authorized Official

Name: ATHANASIUS UMUNNAKWE OHAYA
Title or Position: OWNER
Credential:
Phone: 303-913-6131