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General NPI Number Information
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NPI Number | 1831565621
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Entity Type | Organization
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Legal Business Name | BELLAVISTA PROFESSIONAL COUNSELING CENTER, LLC
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Dates
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Enumeration Date | 08/14/2015
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Last Update Date | 08/14/2015
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Provider Practice Location Address
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Address Line | 190 E 9TH AVE SUITE 140
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City | DENVER
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State | CO
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Zip | 80203-2736
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Country | US
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Telephone | 720-297-6150
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Fax |
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Provider Business Mailing Address
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Address Line | 225 S BROADWAY UNIT 9945
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City | DENVER
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State | CO
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Zip | 80209-1540
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Country | US
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Telephone | 720-297-6150
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST/OWNER
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Name | MR. MANUEL F CARRILLO
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Credential | LCSW
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Telephone | 720-297-6150
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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 | 1580
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License Number State | CO
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