Healthcare Provider Details

I. General information

NPI: 1619300720
Provider Name (Legal Business Name): DYNAMIC DIRECTIONS COUNSELING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2013
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 S BROADWAY STE 1A
CENTENNIAL CO
80122-1064
US

IV. Provider business mailing address

7000 S BROADWAY STE 1A
CENTENNIAL CO
80122-1064
US

V. Phone/Fax

Practice location:
  • Phone: 303-797-1440
  • Fax:
Mailing address:
  • Phone: 303-797-1440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number1667-01
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number1667-01
License Number StateCO

VIII. Authorized Official

Name: MARK PUTNOY
Title or Position: CLINICAL SUPERVISOR
Credential:
Phone: 303-257-6715