MEDICARE: AUSPICIOUS COUNSELING AND LIFE COACHING PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1013638691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUSPICIOUS COUNSELING AND LIFE COACHING PLLC

Provider Business Mailing Address
First Line	:	860 OXFORD LN # B102
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-1963
Country	:	US
Telephone Number	:	616-215-9178
Fax Number	:

Provider Business Practice Location Address
First Line	:	860 OXFORD LN # B102
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-1963
Country	:	US
Telephone Number	:	616-215-9178
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	SYDNEY GOMEZ
Credential	:	LCSW
Telephone Number	:	616-215-9178

Provider Enumeration Date	:	09/12/2022
Last Update Date	:	09/12/2022

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