Healthcare Provider Details

I. General information

NPI: 1164153391
Provider Name (Legal Business Name): OASIS SPRINGS CHILDREN'S COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 N ACADEMY BLVD STE 347
COLORADO SPRINGS CO
80917-5328
US

IV. Provider business mailing address

2790 N ACADEMY BLVD STE 347
COLORADO SPRINGS CO
80917-5328
US

V. Phone/Fax

Practice location:
  • Phone: 719-407-2093
  • Fax:
Mailing address:
  • Phone: 719-407-2093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TAYLOR DAUTAJ
Title or Position: OWNER, LPC
Credential: M.A., LPC
Phone: 817-296-4552