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General NPI Number Information
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NPI Number | 1487025409
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Entity Type | Organization
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Legal Business Name | COLORADO SOUL CARE, LLC
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Dates
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Enumeration Date | 10/16/2015
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Last Update Date | 10/16/2015
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Provider Practice Location Address
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Address Line | 5650 GREENWOOD PLAZA BLVD #202
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-2307
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Country | US
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Telephone | 937-409-4203
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Fax |
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Provider Business Mailing Address
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Address Line | 24562 E EASTER PL
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City | AURORA
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State | CO
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Zip | 80016-4105
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Country | US
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Telephone | 937-409-4203
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Fax |
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Authorized Official
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Title or Position | OWNER, MARRIAGE & FAMILY THERAPIST
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Name | LEE ANN CHADRICK
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Credential | MA, MFTC
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Telephone | 937-409-4203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 13541
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 13541
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License Number State | CO
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