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General NPI Number Information
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NPI Number | 1598902520
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Entity Type | Organization
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Legal Business Name | DEPTHWORKS INC
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Dates
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Enumeration Date | 01/13/2009
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Last Update Date | 01/13/2009
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Provider Practice Location Address
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Address Line | 671 GRANT ST
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City | DENVER
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State | CO
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Zip | 80203-3506
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Country | US
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Telephone | 303-722-6606
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Fax | 303-861-0753
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Provider Business Mailing Address
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Address Line | 4507 E 7TH AVE
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City | DENVER
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State | CO
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Zip | 80220-5011
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Country | US
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Telephone | 303-722-6606
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Fax | 303-861-0753
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MR. PEDER D. FURUSETH
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Credential | LPC
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Telephone | 303-722-6606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC-4858
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License Number State | CO
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