Healthcare Provider Details

I. General information

NPI: 1245626787
Provider Name (Legal Business Name): COLORADO RELATIONSHIP RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 S BELLAIRE ST STE 165
DENVER CO
80222-4310
US

IV. Provider business mailing address

6541 S TABOR ST
LITTLETON CO
80127-4854
US

V. Phone/Fax

Practice location:
  • Phone: 303-217-2658
  • Fax:
Mailing address:
  • Phone: 720-272-9573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberCSW.09923905
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberACD.0000426
License Number StateCO

VIII. Authorized Official

Name: JASON POLK
Title or Position: THERAPIST
Credential: LCSW, LAC
Phone: 720-272-9573