Healthcare Provider Details

I. General information

NPI: 1750514980
Provider Name (Legal Business Name): FAMILIES AT FIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2009
Last Update Date: 09/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7241 S FULTON ST
CENTENNIAL CO
80112-3725
US

IV. Provider business mailing address

7241 S FULTON ST
CENTENNIAL CO
80112-3725
US

V. Phone/Fax

Practice location:
  • Phone: 720-488-3822
  • Fax:
Mailing address:
  • Phone: 720-488-3822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1560-01
License Number StateCO

VIII. Authorized Official

Name: MS. BONNIE MURIEL MUCKLOW
Title or Position: DIRECTOR
Credential: L.M.F.T.
Phone: 303-781-5045