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General NPI Number Information
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NPI Number | 1619300720
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Entity Type | Organization
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Legal Business Name | DYNAMIC DIRECTIONS COUNSELING INC
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Dates
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Enumeration Date | 08/12/2013
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Last Update Date | 08/12/2013
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Provider Practice Location Address
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Address Line | 7000 S BROADWAY STE 1A
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City | CENTENNIAL
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State | CO
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Zip | 80122-1064
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Country | US
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Telephone | 303-797-1440
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Fax |
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Provider Business Mailing Address
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Address Line | 7000 S BROADWAY STE 1A
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City | CENTENNIAL
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State | CO
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Zip | 80122-1064
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Country | US
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Telephone | 303-797-1440
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Fax |
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Authorized Official
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Title or Position | CLINICAL SUPERVISOR
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Name | MARK PUTNOY
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Credential |
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Telephone | 303-257-6715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 1667-01
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 1667-01
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License Number State | CO
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