Healthcare Provider Details

I. General information

NPI: 1427291319
Provider Name (Legal Business Name): HOPE CONNIE CARRANCO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 04/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST UNIT 9
DENVER CO
80204-4507
US

IV. Provider business mailing address

777 BANNOCK ST UNIT 9
DENVER CO
80204-4507
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-3652
  • Fax: 303-436-5071
Mailing address:
  • Phone: 303-436-3652
  • Fax: 303-436-5071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6453
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: