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General NPI Number Information
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NPI Number | 1477700565
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Entity Type | Organization
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Legal Business Name | CANON CITY COUNSELING, INC
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Dates
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Enumeration Date | 08/20/2008
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Last Update Date | 08/20/2008
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Provider Practice Location Address
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Address Line | 224 N COTTONWOOD AVE
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City | CANON CITY
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State | CO
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Zip | 81212-2507
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Country | US
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Telephone | 719-276-0292
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Fax | 719-276-0292
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Provider Business Mailing Address
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Address Line | 224 N COTTONWOOD AVE
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City | CANON CITY
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State | CO
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Zip | 81212-2507
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Country | US
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Telephone | 719-276-0292
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Fax | 719-276-0292
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. SALLY JEAN CHAPMAN
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Credential | LPC
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Telephone | 719-276-0292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 5044
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 6391
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3037
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2425
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License Number State | CO
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