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NPI Code Detail

MEDICARE: COAL CREEK COUNSELING ASSOCIATES

MEDICARE: COAL CREEK COUNSELING ASSOCIATES
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
1261Q00000XClinic/Center

Other Identifiers

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

General Provider Information

NPI Number : 1326556051
Entity Type Code : Organization
Provider Name (Legal Business Name) : COAL CREEK COUNSELING ASSOCIATES
Provider Business Mailing Address
First Line : 1036 LINCOLN AVE
Second Line :
City : LOUISVILLE
State : CO
Zip : 80027-1720
Country : US
Telephone Number : 720-233-5114
Fax Number :
Provider Business Practice Location Address
First Line : 357 MCCASLIN BLVD STE 200
Second Line :
City : LOUISVILLE
State : CO
Zip : 80027-2932
Country : US
Telephone Number : 720-233-5114
Fax Number :
Authorized Official
Title or Position : OWNER
Name : GWENDOLYN GAUMOND
Credential : LPC
Telephone Number : 720-233-5114
Provider Enumeration Date : 01/16/2018
Last Update Date : 01/16/2018

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Directions to “COAL CREEK COUNSELING ASSOCIATES ” Practice Location

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