Healthcare Provider Details

I. General information

NPI: 1407129182
Provider Name (Legal Business Name): COLORADO COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2012
Last Update Date: 12/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6590 S VINE ST SUITE 101
CENTENNIAL CO
80121-2761
US

IV. Provider business mailing address

6590 S VINE ST SUITE 101
CENTENNIAL CO
80121-2761
US

V. Phone/Fax

Practice location:
  • Phone: 720-878-5159
  • Fax:
Mailing address:
  • Phone: 720-468-0101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC 0013940
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09923019
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT 815
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT - 882
License Number StateCO

VIII. Authorized Official

Name: PAUL D SIGAFUS
Title or Position: OWNER & DIRECTOR
Credential: M.S., LMFT
Phone: 720-878-5159