Healthcare Provider Details

I. General information

NPI: 1326913864
Provider Name (Legal Business Name): FAMILY SUPPORT CENTER OF COLORADO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 INDIANA AVE
PUEBLO CO
81004-3572
US

IV. Provider business mailing address

1330 QUAIL LAKE LOOP STE 200
COLORADO SPRINGS CO
80906-4651
US

V. Phone/Fax

Practice location:
  • Phone: 719-540-2152
  • Fax:
Mailing address:
  • Phone: 719-540-2152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHERIE TERRANOVA
Title or Position: OPERATIONS DIRECTOR
Credential:
Phone: 719-540-2152