Healthcare Provider Details

I. General information

NPI: 1184456626
Provider Name (Legal Business Name): RESERVOIR COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3307 S COLLEGE AVE
FORT COLLINS CO
80525-4196
US

IV. Provider business mailing address

1001 E 62ND AVE UNIT 2355
DENVER CO
80216-1362
US

V. Phone/Fax

Practice location:
  • Phone: 307-689-2954
  • Fax:
Mailing address:
  • Phone: 307-689-2954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KAYLA RILEY
Title or Position: OWNER
Credential: M.S. LPC
Phone: 307-689-2954