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General NPI Number Information
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NPI Number | 1245784933
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Entity Type | Organization
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Legal Business Name | TIKKUN COUNSELING GROUP, LLC
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Dates
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Enumeration Date | 08/10/2016
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Last Update Date | 08/10/2016
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Provider Practice Location Address
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Address Line | 3339 W 38TH AVE
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City | DENVER
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State | CO
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Zip | 80211-1909
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Country | US
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Telephone | 303-455-3767
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Fax |
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Provider Business Mailing Address
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Address Line | 2181 S TRENTON WAY 14-204
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City | DENVER
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State | CO
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Zip | 80231-5393
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | JOANNA MARCELA SANTA BERRIO
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Credential |
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Telephone | 415-845-5339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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