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General NPI Number Information
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NPI Number | 1861999500
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Entity Type | Organization
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Legal Business Name | AT YOUR CONVENIENCE MENTAL HEALTH AND RELATIONSHIP COUNSELING OF DENVE
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Dates
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Enumeration Date | 04/10/2018
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Last Update Date | 04/10/2018
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Provider Practice Location Address
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Address Line | 9025 E KENYON AVE
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City | DENVER
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State | CO
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Zip | 80237-1804
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Country | US
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Telephone | 720-266-0489
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Fax |
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Provider Business Mailing Address
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Address Line | 9025 E KENYON AVE
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City | DENVER
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State | CO
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Zip | 80237-1804
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Country | US
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Telephone | 720-266-0489
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Fax |
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Authorized Official
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Title or Position | CEO/LEAD COUNSELOR
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Name | MR. MARK MATTHEW MILLER
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Credential | LPC,LAC
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Telephone | 720-266-0489
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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 | LPC.0014527
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ACD.0000935
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License Number State | CO
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