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General NPI Number Information
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NPI Number | 1255201869
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Entity Type | Organization
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Legal Business Name | ELK MEADOW ENDURING CONNECTIONS, INC.
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Dates
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Enumeration Date | 11/08/2025
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Last Update Date | 11/08/2025
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Provider Practice Location Address
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Address Line | 685 CITADEL DR E STE 510
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-5372
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Country | US
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Telephone | 719-452-0393
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 62359
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City | COLORADO SPRINGS
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State | CO
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Zip | 80962-2359
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Country | US
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Telephone | 719-452-0393
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/CLINICIAN
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Name | MITA M JOHNSON
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Credential | LPC, LMFT, LAC, MAC
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Telephone | 719-452-0393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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