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General NPI Number Information
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NPI Number | 1184274821
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Entity Type | Organization
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Legal Business Name | PRIME COUNSELING, LLC
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Dates
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Enumeration Date | 09/15/2019
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Last Update Date | 05/23/2022
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Provider Practice Location Address
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Address Line | 6746 S REVERE PKWY STE 135
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City | CENTENNIAL
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State | CO
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Zip | 80112-6708
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Country | US
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Telephone | 720-261-8818
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Fax |
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Provider Business Mailing Address
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Address Line | 8979 MINERS PL
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City | HIGHLANDS RANCH
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State | CO
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Zip | 80126-5057
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Country | US
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Telephone | 720-261-8818
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH PROFESSIONAL
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Name | INNA ERMAKOV
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Credential | LPC
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Telephone | 720-261-8818
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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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