Healthcare Provider Details

I. General information

NPI: 1861999500
Provider Name (Legal Business Name): AT YOUR CONVENIENCE MENTAL HEALTH AND RELATIONSHIP COUNSELING OF DENVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9025 E KENYON AVE
DENVER CO
80237-1804
US

IV. Provider business mailing address

9025 E KENYON AVE
DENVER CO
80237-1804
US

V. Phone/Fax

Practice location:
  • Phone: 720-266-0489
  • Fax:
Mailing address:
  • Phone: 720-266-0489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0000935
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0014527
License Number StateCO

VIII. Authorized Official

Name: MR. MARK MATTHEW MILLER
Title or Position: CEO/LEAD COUNSELOR
Credential: LPC,LAC
Phone: 720-266-0489