Healthcare Provider Details

I. General information

NPI: 1316407802
Provider Name (Legal Business Name): OTHER ROAD COUNSELING CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 W 15TH ST STE 2
LOVELAND CO
80538-3551
US

IV. Provider business mailing address

2004 W 15TH ST STE 2
LOVELAND CO
80538-3551
US

V. Phone/Fax

Practice location:
  • Phone: 970-217-2486
  • Fax: 855-217-8024
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MALLORIE SMOLEN
Title or Position: LCSW
Credential: MA
Phone: 860-214-5492