Healthcare Provider Details

I. General information

NPI: 1306302245
Provider Name (Legal Business Name): GROWTH-CHANGE-REFLECTION COUNSELING AND CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2019
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7660 GODDARD ST STE 234
COLORADO SPRINGS CO
80920-8231
US

IV. Provider business mailing address

6660 DELMONICO DR STE D210
COLORADO SPRINGS CO
80919-1899
US

V. Phone/Fax

Practice location:
  • Phone: 719-298-3343
  • Fax: 303-532-5079
Mailing address:
  • Phone: 719-641-6240
  • Fax: 303-532-5079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: ABIGAIL W LAVOO
Title or Position: OWNER-ADMINISTRATOR
Credential: PHD, LPC, LAC
Phone: 719-298-3343