Healthcare Provider Details

I. General information

NPI: 1750059929
Provider Name (Legal Business Name): LUTHERAN SOCIAL SERVICES OF COLORADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 E SAINT VRAIN ST STE 21
COLORADO SPRINGS CO
80903-1161
US

IV. Provider business mailing address

1035 OSAGE ST STE 700
DENVER CO
80204-4209
US

V. Phone/Fax

Practice location:
  • Phone: 719-227-7571
  • Fax:
Mailing address:
  • Phone: 303-922-3433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER BOHANNON
Title or Position: LPC
Credential: LPC
Phone: 970-988-4634