Healthcare Provider Details

I. General information

NPI: 1629468285
Provider Name (Legal Business Name): PURE SPRING FAMILY COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 W 120TH AVE UNIT 200B
BROOMFIELD CO
80020-7604
US

IV. Provider business mailing address

PO BOX 1714
BROOMFIELD CO
80038-1714
US

V. Phone/Fax

Practice location:
  • Phone: 303-842-5781
  • Fax: 303-464-9384
Mailing address:
  • Phone: 303-842-5781
  • Fax: 303-464-9384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JANE COX
Title or Position: CLINICAL DIR/OWNER
Credential: LPC
Phone: 303-842-5781