Healthcare Provider Details

I. General information

NPI: 1699684266
Provider Name (Legal Business Name): BEYOND DA BLOCK YOUTH PEER SUPPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5350 SOLAR RIDGE DR
COLORADO SPRINGS CO
80917-1441
US

IV. Provider business mailing address

5350 SOLAR RIDGE DR
COLORADO SPRINGS CO
80917-1441
US

V. Phone/Fax

Practice location:
  • Phone: 719-351-4809
  • Fax:
Mailing address:
  • Phone: 719-351-4809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: AMANDA DANELLE MARTINEZ
Title or Position: FOUNDER & EXECUTIVE DIRECTOR
Credential:
Phone: 719-351-4809