Healthcare Provider Details

I. General information

NPI: 1356252159
Provider Name (Legal Business Name): COLORADO COUNSELING AND CONSULTING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 N ACADEMY BLVD STE 312
COLORADO SPRINGS CO
80917-5347
US

IV. Provider business mailing address

2790 N ACADEMY BLVD STE 312
COLORADO SPRINGS CO
80917-5347
US

V. Phone/Fax

Practice location:
  • Phone: 719-444-0250
  • Fax:
Mailing address:
  • Phone: 719-444-0250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DUDLEY MEDFORD SIGLER-BLACK
Title or Position: PSYCHOTHERAPIST7194440250
Credential: L.M.F.T.
Phone: 719-444-0250