Healthcare Provider Details

I. General information

NPI: 1053177303
Provider Name (Legal Business Name): VIDA CONSEJERIA INVIDUAL & FAMILIAR PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10465 MELODY DR
NORTHGLENN CO
80234-4119
US

IV. Provider business mailing address

151 HIDDEN OAKS RD
WIMBERLEY TX
78676-6220
US

V. Phone/Fax

Practice location:
  • Phone: 720-823-8340
  • Fax:
Mailing address:
  • Phone: 720-823-8340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. NIDIA A PONCE OROZCO
Title or Position: MENTAL HEALTH
Credential: LCSW
Phone: 720-823-8340