Healthcare Provider Details

I. General information

NPI: 1326889593
Provider Name (Legal Business Name): KNUDSEN COUNSELING EDUCATIONAL AND BUSINESS SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60615 US HIGHWAY 285
BAILEY CO
80421-5053
US

IV. Provider business mailing address

PO BOX 1344
FAIRPLAY CO
80440-1344
US

V. Phone/Fax

Practice location:
  • Phone: 719-960-4598
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: NOLA KNUDSEN
Title or Position: OWNER
Credential:
Phone: 719-960-4598