MEDICARE: YOUTH VENTURES OF COLORADO

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	104100000X	Social Worker

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	:	1417077686
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUTH VENTURES OF COLORADO

Provider Business Mailing Address
First Line	:	4785 GRANBY CIR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-3131
Country	:	US
Telephone Number	:	719-574-3555
Fax Number	:	719-260-0332

Provider Business Practice Location Address
First Line	:	4785 GRANBY CIR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-3131
Country	:	US
Telephone Number	:	719-574-3555
Fax Number	:	719-260-0332

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	KENN BRIGGS
Credential	:	LCSW
Telephone Number	:	719-574-3555

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	08/08/2007

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Directions to “YOUTH VENTURES OF COLORADO ” Practice Location

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