Healthcare Provider Details

I. General information

NPI: 1114095205
Provider Name (Legal Business Name): FRONT RANGE INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2864 S CIRCLE DR SUITE 500
COLORADO SPRINGS CO
80906-4114
US

IV. Provider business mailing address

2864 S CIRCLE DR SUITE 500
COLORADO SPRINGS CO
80906-4114
US

V. Phone/Fax

Practice location:
  • Phone: 719-531-9211
  • Fax: 719-577-9627
Mailing address:
  • Phone: 719-531-9211
  • Fax: 719-577-9627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number989731
License Number StateCO

VIII. Authorized Official

Name: MR. STEVEN PAUL RAUCH
Title or Position: PARTNER
Credential: LCSW
Phone: 719-531-9211