MEDICARE: PARENTING CENTER, LLC

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	251S00000X	Community/Behavioral Health Agency	CSW.09923269	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043622756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARENTING CENTER, LLC

Provider Business Mailing Address
First Line	:	524 N TEJON ST
Second Line	:	SUITE 3
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-4926
Country	:	US
Telephone Number	:	719-201-0887
Fax Number	:	480-275-3789

Provider Business Practice Location Address
First Line	:	524 N TEJON ST
Second Line	:	SUITE 3 - UPSTAIRS
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-4926
Country	:	US
Telephone Number	:	719-201-0887
Fax Number	:	480-275-3789

Authorized Official
Title or Position	:	LCSW
Name	:	JANICE ELIZABETH BLACK
Credential	:	LCSW
Telephone Number	:	719-201-0887

Provider Enumeration Date	:	05/29/2014
Last Update Date	:	05/29/2014

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