Healthcare Provider Details

I. General information

NPI: 1902701147
Provider Name (Legal Business Name): GEESELLE ANTONIA FLORES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 E FOUNTAIN BLVD
COLORADO SPRINGS CO
80910-3502
US

IV. Provider business mailing address

239 ELMWOOD DR
COLORADO SPRINGS CO
80907-4352
US

V. Phone/Fax

Practice location:
  • Phone: 719-632-4569
  • Fax:
Mailing address:
  • Phone: 719-232-3566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: