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General NPI Number Information
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NPI Number | 1245626787
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Entity Type | Organization
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Legal Business Name | COLORADO RELATIONSHIP RECOVERY LLC
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Dates
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Enumeration Date | 04/10/2015
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 1777 S BELLAIRE ST STE 165
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City | DENVER
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State | CO
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Zip | 80222-4310
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Country | US
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Telephone | 303-217-2658
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Fax |
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Provider Business Mailing Address
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Address Line | 6541 S TABOR ST
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City | LITTLETON
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State | CO
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Zip | 80127-4854
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Country | US
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Telephone | 720-272-9573
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | JASON POLK
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Credential | LCSW, LAC
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Telephone | 720-272-9573
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | ACD.0000426
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | CSW.09923905
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License Number State | CO
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