MEDICARE: ALL LIFE LONG COUNSELING AND CONSULTING, PLLC.

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	1041C0700X	Clinical Social Worker	1842	CO

General Provider Information

NPI Number	:	1578920690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL LIFE LONG COUNSELING AND CONSULTING, PLLC.

Provider Business Mailing Address
First Line	:	2316 N WAHSATCH AVE
Second Line	:	SUITE # 240
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-6968
Country	:	US
Telephone Number	:	719-331-7445
Fax Number	:	719-375-3915

Provider Business Practice Location Address
First Line	:	1426 N HANCOCK AVE
Second Line	:	SUITE 5N
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-2618
Country	:	US
Telephone Number	:	719-331-7445
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. DARLENE BECKY AVERY
Credential	:	LCSW
Telephone Number	:	719-331-7445

Provider Enumeration Date	:	01/20/2016
Last Update Date	:	03/31/2016

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