MEDICARE: FRONT RANGE TREATMENT CENTER, LTD.

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	261QM0850X	Adult Mental Health Clinic/Center
2	103T00000X	Psychologist	PSY.0004384	CO

General Provider Information

NPI Number	:	1558875591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRONT RANGE TREATMENT CENTER, LTD.

Provider Business Mailing Address
First Line	:	6075 S QUEBEC ST STE 200
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80111-4535
Country	:	US
Telephone Number	:	720-390-6932
Fax Number	:

Provider Business Practice Location Address
First Line	:	6075 S QUEBEC ST STE 200
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80111-4535
Country	:	US
Telephone Number	:	720-390-6932
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JENELL EFFINGER
Credential	:	PHD
Telephone Number	:	720-390-6932

Provider Enumeration Date	:	11/29/2017
Last Update Date	:	11/18/2021

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