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General NPI Number Information
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NPI Number | 1932261617
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Entity Type | Organization
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Legal Business Name | CANON CITY COUNSELING & PSYCHOTHERAPY SERVICES
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 109 LATIGO LN SUITE E-2
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City | CANON CITY
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State | CO
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Zip | 81212-8112
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Country | US
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Telephone | 719-275-4442
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Fax | 719-275-4442
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Provider Business Mailing Address
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Address Line | 109 LATIGO LN SUITE E-2
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City | CANON CITY
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State | CO
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Zip | 81212-8112
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Country | US
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Telephone | 719-275-4442
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Fax | 719-275-4442
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOHN A MORLOCK
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Credential | MSW LCSW
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Telephone | 719-275-4442
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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 | 992271
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License Number State | CO
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