Healthcare Provider Details

I. General information

NPI: 1467079053
Provider Name (Legal Business Name): CONVENIENT COLORADO COUNSELING LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 09/28/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N CASCADE AVE STE 200
COLORADO SPRINGS CO
80903-3341
US

IV. Provider business mailing address

525 N CASCADE AVE STE 200
COLORADO SPRINGS CO
80903-3341
US

V. Phone/Fax

Practice location:
  • Phone: 719-755-2158
  • Fax:
Mailing address:
  • Phone: 719-755-2158
  • 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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: AMBER KOSLOSKE
Title or Position: COUNSELOR/OWNER
Credential: MS, LPC
Phone: 719-755-2158