Healthcare Provider Details

I. General information

NPI: 1770316416
Provider Name (Legal Business Name): SUNRISE COUNSELING AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 FREMONT DR STE E
CANON CITY CO
81212-2404
US

IV. Provider business mailing address

1811 FREMONT DR STE E
CANON CITY CO
81212-2404
US

V. Phone/Fax

Practice location:
  • Phone: 719-308-5450
  • 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 Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH FARRIS
Title or Position: OWNER
Credential: LCSW, LAC
Phone: 719-308-5450