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General NPI Number Information
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NPI Number | 1013402387
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Entity Type | Organization
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Legal Business Name | SPECIAL KIDS SPECIAL FAMILIES
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Dates
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Enumeration Date | 06/28/2018
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Last Update Date | 06/28/2018
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Provider Practice Location Address
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Address Line | 424 W PIKES PEAK AVE
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City | COLORADO SPRINGS
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State | CO
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Zip | 80905-1525
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Country | US
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Telephone | 719-447-8983
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Fax | 719-447-9482
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Provider Business Mailing Address
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Address Line | 3830 STETSON CT
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-4906
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Country | US
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Telephone | 720-988-9511
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Fax | 719-345-1820
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LINDA K ELLEGARD
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Credential | LPC
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Telephone | 719-447-8983
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State | CO
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