MEDICARE: COLORADO SPRINGS OCD & TRAUMA TREATMENT 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	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649818865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO SPRINGS OCD & TRAUMA TREATMENT CENTER

Provider Business Mailing Address
First Line	:	2140 ACADEMY CIR STE C-1
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1690
Country	:	US
Telephone Number	:	719-287-8341
Fax Number	:

Provider Business Practice Location Address
First Line	:	2140 ACADEMY CIR STE C-1
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1690
Country	:	US
Telephone Number	:	719-287-8341
Fax Number	:

Authorized Official
Title or Position	:	LPC/FOUNDER
Name	:	KAYLA ENGEL
Credential	:	LPC, NCC, MS
Telephone Number	:	719-287-8341

Provider Enumeration Date	:	12/18/2019
Last Update Date	:	12/18/2019

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