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General NPI Number Information
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NPI Number | 1447883566
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Entity Type | Organization
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Legal Business Name | MOUNT TABOR COUNSELING
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Dates
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Enumeration Date | 02/17/2020
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Last Update Date | 10/16/2023
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Provider Practice Location Address
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Address Line | 5945 WARD RD STE 100
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City | ARVADA
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State | CO
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Zip | 80004-3901
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Country | US
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Telephone | 303-422-1567
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Fax |
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Provider Business Mailing Address
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Address Line | 12500 W 58TH AVE UNIT 211
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City | ARVADA
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State | CO
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Zip | 80002-1104
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Country | US
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Telephone | 303-422-1567
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RYAN BALKE
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Credential |
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Telephone | 303-422-1567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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