MEDICARE: AGAPE TREATMENT SOLUTIONS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1588177620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGAPE TREATMENT SOLUTIONS

Provider Business Mailing Address
First Line	:	4725 MEADOWLAND BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-2609
Country	:	US
Telephone Number	:	719-232-7981
Fax Number	:

Provider Business Practice Location Address
First Line	:	1353 S 8TH ST STE 202
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-7341
Country	:	US
Telephone Number	:	719-232-7981
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SALENA ETHALENA, ARNETTA MANAOIS
Credential	:	MA, LAC, LPCC, CNA
Telephone Number	:	719-232-7981

Provider Enumeration Date	:	11/12/2017
Last Update Date	:	11/12/2017

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Directions to “AGAPE TREATMENT SOLUTIONS ” Practice Location

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