=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487408902
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALDERWOOD COUNSELING PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2024
-----------------------------------------------------
Last Update Date | 04/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 920 DEER MEADOW WAY
-----------------------------------------------------
City | LIVERMORE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80536-9505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-344-1992
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 920 DEER MEADOW WAY
-----------------------------------------------------
City | LIVERMORE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80536-9505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-344-1992
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CHERI TRAHAN KEENE
-----------------------------------------------------
Credential | PHD LPC
-----------------------------------------------------
Telephone | 409-344-1992
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC1900X
-----------------------------------------------------
Taxonomy Name | Counseling Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------