MEDICARE: ABUNDANT LIFE COUNSELING

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1073166716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABUNDANT LIFE COUNSELING

Provider Business Mailing Address
First Line	:	6105 S MAIN ST STE 218
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80016-5361
Country	:	US
Telephone Number	:	720-277-9508
Fax Number	:

Provider Business Practice Location Address
First Line	:	6105 S MAIN ST STE 218
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80016-5361
Country	:	US
Telephone Number	:	720-277-9508
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	CARRIE CHATTERTON
Credential	:	MA LPC
Telephone Number	:	303-995-7882

Provider Enumeration Date	:	07/22/2019
Last Update Date	:	07/22/2019

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