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General NPI Number Information
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NPI Number | 1760950232
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Entity Type | Organization
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Legal Business Name | SPECIALIZED COUNSELING COLORADO
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Dates
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Enumeration Date | 11/02/2018
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Last Update Date | 07/19/2019
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Provider Practice Location Address
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Address Line | 13701 W JEWELL AVE # 200-6
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City | LAKEWOOD
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State | CO
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Zip | 80228-4139
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Country | US
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Telephone | 720-909-9910
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Fax |
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Provider Business Mailing Address
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Address Line | 13135 W 2ND PL APT D3532
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City | LAKEWOOD
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State | CO
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Zip | 80228-1472
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Country | US
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Telephone | 720-909-9910
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Fax |
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Authorized Official
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Title or Position | LPC
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Name | COLIN DAVID RUNGE
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Credential | LPC
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Telephone | 720-909-9910
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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 |
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License Number State |
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