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General NPI Number Information
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NPI Number | 1750514980
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Entity Type | Organization
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Legal Business Name | FAMILIES AT FIVE
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Dates
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Enumeration Date | 09/04/2009
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Last Update Date | 09/04/2009
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Provider Practice Location Address
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Address Line | 7241 S FULTON ST
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City | CENTENNIAL
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State | CO
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Zip | 80112-3725
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Country | US
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Telephone | 720-488-3822
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Fax |
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Provider Business Mailing Address
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Address Line | 7241 S FULTON ST
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City | CENTENNIAL
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State | CO
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Zip | 80112-3725
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Country | US
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Telephone | 720-488-3822
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. BONNIE MURIEL MUCKLOW
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Credential | L.M.F.T.
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Telephone | 303-781-5045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1560-01
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License Number State | CO
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