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General NPI Number Information
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NPI Number | 1013628015
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Entity Type | Organization
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Legal Business Name | THE DALE HOUSE PROJECT
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Dates
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Enumeration Date | 12/09/2022
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Last Update Date | 12/09/2022
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Provider Practice Location Address
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Address Line | 802 N TEJON ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-3209
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Country | US
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Telephone | 719-471-0642
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Fax |
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Provider Business Mailing Address
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Address Line | 7 W DALE ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-3209
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Country | US
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Telephone | 719-471-0642
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Fax |
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Authorized Official
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Title or Position | CO-EXECUTIVE DIRECTOR
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Name | ERIC LANGE
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Credential | REV
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Telephone | 719-471-0642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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