MEDICARE: DENVER CENTER FOR INTEGRATED COUNSELING 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	101YP2500X	Professional Counselor	2585	CO
2	1041C0700X	Clinical Social Worker	09923512	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	:	1154707396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENVER CENTER FOR INTEGRATED COUNSELING LLC

Provider Business Mailing Address
First Line	:	8000 E PRENTICE AVE STE B2
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-2726
Country	:	US
Telephone Number	:	515-229-6777
Fax Number	:

Provider Business Practice Location Address
First Line	:	8000 E PRENTICE AVE STE B2
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-2726
Country	:	US
Telephone Number	:	515-229-6777
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PSYCHOTHERAPIST
Name	:	PATRICK GERARD WEEG
Credential	:	LCSW
Telephone Number	:	515-229-6777

Provider Enumeration Date	:	08/10/2015
Last Update Date	:	08/10/2015

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