Healthcare Provider Details

I. General information

NPI: 1396105359
Provider Name (Legal Business Name): PEAK TO PEAK COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2016
Last Update Date: 03/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 E 8TH AVE STE 204
DURANGO CO
81301-5708
US

IV. Provider business mailing address

270 E 8TH AVE STE 204
DURANGO CO
81301-5708
US

V. Phone/Fax

Practice location:
  • Phone: 970-946-8074
  • Fax:
Mailing address:
  • Phone: 970-946-8074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW-1206
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SEAN MICHAEL HEIN
Title or Position: PROPRIETOR
Credential: LCSW
Phone: 970-946-8074