MEDICARE: KALEIDOSCOPE THERAPY SERVICES, 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1164805743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KALEIDOSCOPE THERAPY SERVICES, LLC

Provider Business Mailing Address
First Line	:	1496 S BRENTWOOD ST
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80232-5331
Country	:	US
Telephone Number	:	303-829-7904
Fax Number	:

Provider Business Practice Location Address
First Line	:	1496 S BRENTWOOD ST
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80232-5331
Country	:	US
Telephone Number	:	303-829-7904
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR AND LEAD THERAPIST
Name	:	MRS. KELLY GARCIA-BRAUCH
Credential	:	LPC
Telephone Number	:	303-829-7904

Provider Enumeration Date	:	07/01/2015
Last Update Date	:	06/14/2023

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