Healthcare Provider Details

I. General information

NPI: 1083123061
Provider Name (Legal Business Name): SHE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2017
Last Update Date: 09/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12021 PENNSYLVANIA ST STE 205
THORNTON CO
80241-3152
US

IV. Provider business mailing address

13734 COLUMBINE ST
THORNTON CO
80602-7243
US

V. Phone/Fax

Practice location:
  • Phone: 303-218-5259
  • Fax:
Mailing address:
  • Phone: 309-236-4831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0013606
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number0013606
License Number StateCO

VIII. Authorized Official

Name: BRANDY MARTIN
Title or Position: OWNER
Credential: LPC
Phone: 303-218-5259