Healthcare Provider Details

I. General information

NPI: 1710374640
Provider Name (Legal Business Name): COMANCHE CROSSING COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 S 1ST ST
BENNETT CO
80102-7860
US

IV. Provider business mailing address

190 S 1ST ST
BENNETT CO
80102-7860
US

V. Phone/Fax

Practice location:
  • Phone: 303-644-4240
  • Fax: 303-644-4250
Mailing address:
  • Phone: 303-644-4240
  • Fax: 303-644-4250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCSW00001915
License Number StateCO

VIII. Authorized Official

Name: MARLA M MADRID
Title or Position: OWNER
Credential: MSW, LCSW, LAC, LMFT
Phone: 303-644-4240