=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962862706
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AERIE COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2016
-----------------------------------------------------
Last Update Date | 03/04/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 88 INVERNESS CIR E BUILDING E - SUITE 103
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80112-5304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-465-1448
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9110 E ARBOR CIR APT. A
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80111-5212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BETHANY ALBRECHT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 720-465-1448
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 0012872
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------