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NPI Code Detail

MEDICARE: PROJECT EMBER COUNSELING

MEDICARE: PROJECT EMBER COUNSELING
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
1106H00000XMarriage & Family Therapist

Other Identifiers

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

General Provider Information

NPI Number : 1720600455
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROJECT EMBER COUNSELING
Provider Business Mailing Address
First Line : 4360 MONTEBELLO DR STE 400
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80918-7224
Country : US
Telephone Number : 719-246-5693
Fax Number :
Provider Business Practice Location Address
First Line : 4360 MONTEBELLO DR STE 400
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80918-7224
Country : US
Telephone Number : 719-246-5693
Fax Number :
Authorized Official
Title or Position : OWNER/PRESIDENT
Name : KYLE BRIDGMAN
Credential : LMFT
Telephone Number : 719-246-5693
Provider Enumeration Date : 05/15/2020
Last Update Date : 05/21/2021

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Directions to “PROJECT EMBER COUNSELING ” Practice Location

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