Healthcare Provider Details

I. General information

NPI: 1558875591
Provider Name (Legal Business Name): FRONT RANGE TREATMENT CENTER, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2017
Last Update Date: 11/18/2021
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6075 S QUEBEC ST STE 200
CENTENNIAL CO
80111-4535
US

IV. Provider business mailing address

6075 S QUEBEC ST STE 200
CENTENNIAL CO
80111-4535
US

V. Phone/Fax

Practice location:
  • Phone: 720-390-6932
  • Fax:
Mailing address:
  • Phone: 720-390-6932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY.0004384
License Number StateCO

VIII. Authorized Official

Name: DR. JENELL EFFINGER
Title or Position: OWNER
Credential: PHD
Phone: 720-390-6932