Healthcare Provider Details

I. General information

NPI: 1598539041
Provider Name (Legal Business Name): COALITION FOR QUEER JOY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 11/14/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2770 ARAPAHOE RD STE 132
LAFAYETTE CO
80026-8016
US

IV. Provider business mailing address

2770 ARAPAHOE ROAD STE 132 - MAILBOX 545
LAFAYETTE CO
80026
US

V. Phone/Fax

Practice location:
  • Phone: 720-580-0393
  • Fax:
Mailing address:
  • Phone: 720-580-0393
  • 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: RIKKI CLOS
Title or Position: THERAPIST
Credential: LCSW
Phone: 720-580-0393