Healthcare Provider Details

I. General information

NPI: 1396415501
Provider Name (Legal Business Name): THECOOLLINEORG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2021
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12157 W CEDAR DR STE 202
LAKEWOOD CO
80228-2100
US

IV. Provider business mailing address

3027 KNOLLS END DR UNIT 5
FORT COLLINS CO
80526-5827
US

V. Phone/Fax

Practice location:
  • Phone: 303-357-9743
  • Fax: 303-985-7882
Mailing address:
  • Phone: 303-357-9743
  • Fax: 303-985-7882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. PAULA R CANNON GABLE
Title or Position: FOUNDER, EXEC. DIRECTOR, THERAPIST
Credential: LMFT, ADDC
Phone: 303-357-9743