Healthcare Provider Details

I. General information

NPI: 1184494478
Provider Name (Legal Business Name): REALSIGHT COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/08/2024
Certification Date: 01/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 N HARRISON AVE UNIT A
LAFAYETTE CO
80026-2310
US

IV. Provider business mailing address

104 N HARRISON AVE UNIT A
LAFAYETTE CO
80026-2310
US

V. Phone/Fax

Practice location:
  • Phone: 303-578-2556
  • Fax:
Mailing address:
  • Phone: 303-578-2556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH MARIE REYNOLDS
Title or Position: CLINICAL SOCIAL WORKER/COUNSELOR
Credential: LCSW
Phone: 303-578-2556