Healthcare Provider Details

I. General information

NPI: 1316487937
Provider Name (Legal Business Name): COMPREHENSIVE CHILD COUNSELING & ASSESSMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 UINTA WAY SUITE 120
DENVER CO
80230-7110
US

IV. Provider business mailing address

495 UINTA WAY SUITE 120
DENVER CO
80230-7110
US

V. Phone/Fax

Practice location:
  • Phone: 303-344-4100
  • Fax: 303-484-3575
Mailing address:
  • Phone: 303-344-4100
  • Fax: 303-484-3575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0107323
License Number StateCO

VIII. Authorized Official

Name: MS. ALEXANDRA BECKER
Title or Position: REGISTERED PSYCHOTHERAPIST
Credential:
Phone: 201-213-9909