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General NPI Number Information
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NPI Number | 1417335035
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Entity Type | Organization
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Legal Business Name | IN THE MOMENT COUNSELING, LLC
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Dates
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Enumeration Date | 05/14/2015
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Last Update Date | 05/14/2015
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Provider Practice Location Address
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Address Line | 201 S WILCOX ST SUITE 202
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City | CASTLE ROCK
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State | CO
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Zip | 80104-3315
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Country | US
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Telephone | 720-295-1199
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Fax | 720-634-0646
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Provider Business Mailing Address
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Address Line | 201 S WILCOX ST SUITE 202
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City | CASTLE ROCK
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State | CO
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Zip | 80104-3315
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Country | US
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Telephone | 720-295-1199
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Fax | 720-634-0646
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KENDRA LIEDTKE
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Credential | LCSW
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Telephone | 720-295-1199
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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 | 992871
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License Number State | CO
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