Healthcare Provider Details

I. General information

NPI: 1982922431
Provider Name (Legal Business Name): NORTH STAR COUNSELING SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 05/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13569 W PURDUE AVE
MORRISON CO
80465-1104
US

IV. Provider business mailing address

13569 W PURDUE AVE
MORRISON CO
80465-1104
US

V. Phone/Fax

Practice location:
  • Phone: 720-579-7011
  • Fax:
Mailing address:
  • Phone: 720-579-7011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW-1417
License Number StateCO

VIII. Authorized Official

Name: MR. DOUGLAS ROCKWELL CLAWSON
Title or Position: LCSW/SOLE PROPRIETOR
Credential: LCSW
Phone: 720-579-7011