Healthcare Provider Details

I. General information

NPI: 1578064994
Provider Name (Legal Business Name): ORIGINAL PATH COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 03/31/2024
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6551 S REVERE PKWY STE 160
CENTENNIAL CO
80111-6469
US

IV. Provider business mailing address

6551 S REVERE PKWY STE 160
CENTENNIAL CO
80111-6469
US

V. Phone/Fax

Practice location:
  • Phone: 720-735-7444
  • Fax:
Mailing address:
  • Phone: 720-735-7444
  • 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 Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: AMANDA HORAK
Title or Position: OWNER/ LPC
Credential:
Phone: 720-725-7444