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General NPI Number Information
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NPI Number | 1477064590
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Entity Type | Organization
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Legal Business Name | MISSION POSSIBLE
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Dates
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Enumeration Date | 10/16/2017
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 1520 N UNION BLVD STE 204
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-2840
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Country | US
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Telephone | 719-635-9100
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80932-0100
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Country | US
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Telephone | 719-635-9100
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Fax | 719-442-1500
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. PALMER W JOHNSON
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Credential | MSW, LCSW
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Telephone | 719-635-9100
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 991344
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License Number State | CO
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