=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306302245
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GROWTH-CHANGE-REFLECTION COUNSELING AND CONSULTING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2019
-----------------------------------------------------
Last Update Date | 05/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7660 GODDARD ST STE 234
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80920-8231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-298-3343
-----------------------------------------------------
Fax | 303-532-5079
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6660 DELMONICO DR STE D210
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80919-1899
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-641-6240
-----------------------------------------------------
Fax | 303-532-5079
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER-ADMINISTRATOR
-----------------------------------------------------
Name | ABIGAIL W LAVOO
-----------------------------------------------------
Credential | PHD, LPC, LAC
-----------------------------------------------------
Telephone | 719-298-3343
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------