Healthcare Provider Details

I. General information

NPI: 1578907234
Provider Name (Legal Business Name): ALTERNATIVES, BELIEFS & CHOICES COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2013
Last Update Date: 11/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 MAPLE ST
FORT MORGAN CO
80701-2544
US

IV. Provider business mailing address

607 MAPLE ST
FORT MORGAN CO
80701-2544
US

V. Phone/Fax

Practice location:
  • Phone: 970-867-2125
  • Fax: 970-867-4495
Mailing address:
  • Phone: 970-867-2125
  • Fax: 970-867-4495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACC4259
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2936
License Number StateCO

VIII. Authorized Official

Name: EVA K EBERHARDT
Title or Position: DIRECTOR
Credential: LPC, CACIII, NCC
Phone: 970-867-2125