Healthcare Provider Details

I. General information

NPI: 1356279988
Provider Name (Legal Business Name): NEURODIVERGENT & CO. COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19590 E MAINSTREET STE 202
PARKER CO
80138-7371
US

IV. Provider business mailing address

19590 E MAINSTREET STE 202
PARKER CO
80138-7371
US

V. Phone/Fax

Practice location:
  • Phone: 720-772-1608
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DANIELLE OETJEN
Title or Position: THERAPIST
Credential: LPC
Phone: 303-242-6194