MEDICARE: PURE SPRING FAMILY COUNSELING CENTER

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	101YM0800X	Mental Health Counselor		CO
2	101YA0400X	Addiction (Substance Use Disorder) Counselor		CO

General Provider Information

NPI Number	:	1629468285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURE SPRING FAMILY COUNSELING CENTER

Provider Business Mailing Address
First Line	:	PO BOX 1714
Second Line	:
City	:	BROOMFIELD
State	:	CO
Zip	:	80038-1714
Country	:	US
Telephone Number	:	303-842-5781
Fax Number	:	303-464-9384

Provider Business Practice Location Address
First Line	:	7050 W 120TH AVE UNIT 200B
Second Line	:
City	:	BROOMFIELD
State	:	CO
Zip	:	80020-7604
Country	:	US
Telephone Number	:	303-842-5781
Fax Number	:	303-464-9384

Authorized Official
Title or Position	:	CLINICAL DIR/OWNER
Name	:	JANE COX
Credential	:	LPC
Telephone Number	:	303-842-5781

Provider Enumeration Date	:	02/03/2015
Last Update Date	:	02/03/2015

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