Healthcare Provider Details

I. General information

NPI: 1912814625
Provider Name (Legal Business Name): SRD COUNSELING AND CONSULTATION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N GRANT ST STE R
DENVER CO
80203-1859
US

IV. Provider business mailing address

2250 YEARLING DR APT 302
FORT COLLINS CO
80525-4470
US

V. Phone/Fax

Practice location:
  • Phone: 720-491-1457
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL DAVIS
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 302-668-4385