=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366864662
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALINA GALUSHKO MITCHELL M.A.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2014
-----------------------------------------------------
Last Update Date | 09/27/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9250 E COSTILLA AVE STE 535
-----------------------------------------------------
City | GREENWOOD VILLAGE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80112-3679
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-299-9880
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9250 E COSTILLA AVE STE 535
-----------------------------------------------------
City | GREENWOOD VILLAGE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80112-3679
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-299-9880
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LPC .0011207
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------