Healthcare Provider Details

I. General information

NPI: 1467466714
Provider Name (Legal Business Name): COLORADO PLAINS COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 09/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 1ST ST UNIT F
EATON CO
80615-3477
US

IV. Provider business mailing address

PO BOX 1082
AULT CO
80610-1082
US

V. Phone/Fax

Practice location:
  • Phone: 970-302-4667
  • Fax:
Mailing address:
  • Phone: 970-302-4667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3704
License Number StateCO

VIII. Authorized Official

Name: MS. SHAKIRAH C HEMSTROM
Title or Position: OWNER/OPERATOR
Credential: LPC
Phone: 970-302-4667