Healthcare Provider Details

I. General information

NPI: 1588177620
Provider Name (Legal Business Name): AGAPE TREATMENT SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2017
Last Update Date: 11/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1353 S 8TH ST STE 202
COLORADO SPRINGS CO
80905-7341
US

IV. Provider business mailing address

4725 MEADOWLAND BLVD
COLORADO SPRINGS CO
80918-2609
US

V. Phone/Fax

Practice location:
  • Phone: 719-232-7981
  • Fax:
Mailing address:
  • Phone: 719-232-7981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SALENA ETHALENA, ARNETTA MANAOIS
Title or Position: CEO
Credential: MA, LAC, LPCC, CNA
Phone: 719-232-7981