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General NPI Number Information
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NPI Number | 1710013073
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Entity Type | Organization
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Legal Business Name | COMMUNITY REACH CENTER
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8989 HURON ST
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City | THORNTON
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State | CO
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Zip | 80260-6858
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Country | US
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Telephone | 303-853-3697
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Fax |
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Provider Business Mailing Address
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Address Line | 13293 NIWOT TRL
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City | BROOMFIELD
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State | CO
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Zip | 80020-5580
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Country | US
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Telephone | 202-543-3894
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Fax |
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Authorized Official
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Title or Position | PROGAM MANAGER
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Name | MS. TRACELL ANN WEISS
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Credential |
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Telephone | 303-853-3697
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT 502
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License Number State | CO
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