=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235820838
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TABULA RASA COUNSELING, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2023
-----------------------------------------------------
Last Update Date | 09/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3955 E EXPOSITION AVE STE 320
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80209-5033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-457-4580
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2875 S XANADU WAY
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80014-3447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-670-0281
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR/THERAPIST
-----------------------------------------------------
Name | CARA FAITH CZARNECKI
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 720-457-4580
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------