Healthcare Provider Details

I. General information

NPI: 1194366153
Provider Name (Legal Business Name): REACHING HANDS AS EACH ONE TEACHINGS ONE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2019
Last Update Date: 10/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 GALLEY RD
COLORADO SPRINGS CO
80915-2735
US

IV. Provider business mailing address

4720 GALLEY RD
COLORADO SPRINGS CO
80915-2735
US

V. Phone/Fax

Practice location:
  • Phone: 719-999-5054
  • Fax:
Mailing address:
  • Phone: 719-999-5054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional 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: DR. JOHN YUMA BRANNON
Title or Position: LEAD CLINICIAN
Credential: DMIN, CMIT, CCBT
Phone: 719-999-5054