Healthcare Provider Details

I. General information

NPI: 1215525753
Provider Name (Legal Business Name): CHILD COMMUNITY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 01/08/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 E LA SALLE ST STE 108
COLORADO SPRINGS CO
80909-2358
US

IV. Provider business mailing address

2210 E LA SALLE ST STE 108
COLORADO SPRINGS CO
80909-2358
US

V. Phone/Fax

Practice location:
  • Phone: 719-440-6445
  • Fax: 719-374-5907
Mailing address:
  • Phone: 719-440-6445
  • Fax: 719-374-5907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE TALBOTT
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 719-641-6723