Healthcare Provider Details

I. General information

NPI: 1477131795
Provider Name (Legal Business Name): GOOD PLACE PROVIDER NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 03/30/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1624 MARKET ST STE 202
DENVER CO
80202-1518
US

IV. Provider business mailing address

1624 MARKET ST STE 202
DENVER CO
80202-1518
US

V. Phone/Fax

Practice location:
  • Phone: 720-770-8484
  • Fax:
Mailing address:
  • Phone: 720-770-8484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA WRIGHT
Title or Position: CLINICAL DIRECTOR
Credential: LCSW
Phone: 720-770-8484