=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235672031
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JULIE REICHENBERGER, MA, LPC, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2016
-----------------------------------------------------
Last Update Date | 11/28/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1780 SOUTH BELLAIRE STREET, SUITE 485
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-809-3341
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1780 S BELLAIRE ST STE 485
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80222-4326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-809-3341
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JULIE REICHENBERGER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 312-720-7965
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | LPC11098
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------