Healthcare Provider Details

I. General information

NPI: 1043406531
Provider Name (Legal Business Name): D E SCHENK PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 W 14TH STREET
DURANGO CO
87301
US

IV. Provider business mailing address

PO BOX 582
DURANGO CO
81302
US

V. Phone/Fax

Practice location:
  • Phone: 970-385-7933
  • Fax: 970-385-7933
Mailing address:
  • Phone: 970-385-7933
  • Fax: 970-385-7933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number3125
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5702
License Number StateCO

VIII. Authorized Official

Name: MS. DENISE E SCHENK BASLEY
Title or Position: OWNER PSYCHOTHERAPIST
Credential: MA LPC CAC III
Phone: 970-385-7933