Healthcare Provider Details

I. General information

NPI: 1306650387
Provider Name (Legal Business Name): SURFACE CREEK COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2025
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

494 HIGHWAY 92 STE 300
DELTA CO
81416-3441
US

IV. Provider business mailing address

13373 2600 RD
ECKERT CO
81418-8500
US

V. Phone/Fax

Practice location:
  • Phone: 970-835-9223
  • Fax: 970-835-9230
Mailing address:
  • Phone: 970-901-1590
  • Fax: 970-835-9230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHANNON APRIL FRITCHMAN
Title or Position: OWNER/MEMBER
Credential: LPC
Phone: 970-835-9223