MEDICARE: ELK MEADOW ENDURING CONNECTIONS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	3245S0500X	Children's Substance Abuse Rehabilitation Facility
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
4	101YP2500X	Professional Counselor
5	261QC1500X	Community Health Clinic/Center
6	101YM0800X	Mental Health Counselor
7	101YA0400X	Addiction (Substance Use Disorder) Counselor
8	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1457191769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELK MEADOW ENDURING CONNECTIONS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 62359
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80962-2359
Country	:	US
Telephone Number	:	303-808-8466
Fax Number	:

Provider Business Practice Location Address
First Line	:	685 CITADEL DR E STE 510
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-5372
Country	:	US
Telephone Number	:	303-808-8466
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MITA M JOHNSON
Credential	:	LPC, LMFT, LAC
Telephone Number	:	303-808-8466

Provider Enumeration Date	:	05/27/2024
Last Update Date	:	11/21/2025

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