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General NPI Number Information
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NPI Number | 1891394177
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Entity Type | Organization
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Legal Business Name | EXPERIENTIAL FAMILY THERAPY AND TRAINING CENTER, LLC
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Dates
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Enumeration Date | 10/19/2020
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Last Update Date | 10/19/2020
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Provider Practice Location Address
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Address Line | 7175 W JEFFERSON AVE STE 1200
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City | LAKEWOOD
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State | CO
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Zip | 80235-2380
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Country | US
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Telephone | 720-757-1988
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Fax | 720-306-5522
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Provider Business Mailing Address
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Address Line | 2974 W CHENANGO AVE
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City | ENGLEWOOD
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State | CO
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Zip | 80110-6308
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Country | US
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Telephone | 720-757-1988
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | LACIE KILLION
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Credential | MA, LMFT, LAC, RPT
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Telephone | 720-757-1988
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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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