Healthcare Provider Details

I. General information

NPI: 1376219055
Provider Name (Legal Business Name): KENOSIS COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2021
Last Update Date: 08/21/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2770 ARAPAHOE RD STE 132-1027
LAFAYETTE CO
80026-8018
US

IV. Provider business mailing address

2770 ARAPAHOE RD STE 132-1027
LAFAYETTE CO
80026-8018
US

V. Phone/Fax

Practice location:
  • Phone: 303-717-8094
  • Fax:
Mailing address:
  • Phone: 303-717-8094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELISSA RADDATZ
Title or Position: OWNER/PRIVATE PRACTIONER
Credential:
Phone: 303-717-8094