Healthcare Provider Details

I. General information

NPI: 1013302074
Provider Name (Legal Business Name): CREDO COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 PITKIN AVE STE 102
GRAND JUNCTION CO
81501-7805
US

IV. Provider business mailing address

215 PITKIN AVE STE 102
GRAND JUNCTION CO
81501-7805
US

V. Phone/Fax

Practice location:
  • Phone: 970-986-8668
  • Fax: 970-986-8586
Mailing address:
  • Phone: 970-986-8668
  • Fax: 970-986-8586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2182
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CARLEEN MICHELLE BRYANT
Title or Position: CLINICAL THERAPIST
Credential: LPCMH
Phone: 970-986-8668