Healthcare Provider Details

I. General information

NPI: 1871955690
Provider Name (Legal Business Name): CONNECTIONS HOME BASED COUNSELING AND CONSULTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 SNOWMASS DR
LIVERMORE CO
80536-8706
US

IV. Provider business mailing address

PO BOX 27
LIVERMORE CO
80536-0027
US

V. Phone/Fax

Practice location:
  • Phone: 970-568-2905
  • Fax:
Mailing address:
  • Phone: 970-568-2905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW1963
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberCSW.00001963
License Number StateCO

VIII. Authorized Official

Name: DR. DOROTHY FARREL
Title or Position: OWNER
Credential: DM, LCSW
Phone: 970-568-2905