Healthcare Provider Details

I. General information

NPI: 1497223234
Provider Name (Legal Business Name): INTERMOUNTAIN COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 10/01/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6180 LEHMAN DR. STE 100
COLORADO SPRINGS CO
80918-3444
US

IV. Provider business mailing address

6180 LEHMAN DR. STE 100
COLORADO SPRINGS CO
80918-3203
US

V. Phone/Fax

Practice location:
  • Phone: 719-357-6031
  • Fax: 719-691-7005
Mailing address:
  • Phone: 719-203-9499
  • Fax: 719-691-7005

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 Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ROBERT CARLSON
Title or Position: PRESIDENT/DIRECTOR
Credential: LPC
Phone: 719-203-9499