Healthcare Provider Details

I. General information

NPI: 1255201869
Provider Name (Legal Business Name): ELK MEADOW ENDURING CONNECTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2025
Last Update Date: 11/08/2025
Certification Date: 11/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 CITADEL DR E STE 510
COLORADO SPRINGS CO
80909-5372
US

IV. Provider business mailing address

PO BOX 62359
COLORADO SPRINGS CO
80962-2359
US

V. Phone/Fax

Practice location:
  • Phone: 719-452-0393
  • Fax:
Mailing address:
  • Phone: 719-452-0393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: MITA M JOHNSON
Title or Position: EXECUTIVE DIRECTOR/CLINICIAN
Credential: LPC, LMFT, LAC, MAC
Phone: 719-452-0393