Healthcare Provider Details

I. General information

NPI: 1649700790
Provider Name (Legal Business Name): NEW BEGINNINGS COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 VALLEY RD STE I
CANON CITY CO
81212-4176
US

IV. Provider business mailing address

PO BOX 62
CANON CITY CO
81215-0062
US

V. Phone/Fax

Practice location:
  • Phone: 719-371-2767
  • Fax:
Mailing address:
  • Phone: 719-371-2767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. REBECCA K. ROMANO
Title or Position: OWNER, OPERATER
Credential: LPC, NCC
Phone: 719-371-2767