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General NPI Number Information
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NPI Number | 1831251016
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Entity Type | Organization
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Legal Business Name | SPANISH PEAKS MENTAL HEALTH CENTER
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1304 CHINOOK LN
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City | PUEBLO
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State | CO
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Zip | 81001-1851
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Country | US
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Telephone | 719-545-2746
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Fax | 719-584-0119
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Provider Business Mailing Address
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Address Line | 1012 W ABRIENDO AVE
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City | PUEBLO
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State | CO
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Zip | 81004-1128
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Country | US
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Telephone | 719-545-2746
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Fax | 719-584-0119
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Authorized Official
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Title or Position | COUNSELOR
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Name | CATHLEEN O'NEIL
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Credential | LCSW
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Telephone | 719-545-2746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 445
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License Number State | CO
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