=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790466050
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADDICTION COUNSELING SERVICES OF COLORADO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2023
-----------------------------------------------------
Last Update Date | 07/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1011 S VALENTIA ST UNIT 85
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80247-6815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-564-1868
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1011 S VALENTIA ST UNIT 85
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80247-6815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-564-1868
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MINDY HORWITZ
-----------------------------------------------------
Credential | CAS NCACII
-----------------------------------------------------
Telephone | 303-564-1868
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------