MEDICARE: SACRED SPIRIT COUNSELING AND WELLNESS CENTER LLC

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

General Provider Information

NPI Number	:	1730967498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SACRED SPIRIT COUNSELING AND WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	6278 JOHN MUIR TRL
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80927-4161
Country	:	US
Telephone Number	:	727-698-3804
Fax Number	:

Provider Business Practice Location Address
First Line	:	6278 JOHN MUIR TRL
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80927-4161
Country	:	US
Telephone Number	:	727-698-3804
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	PENELOPE J HAZINAKIS-SWAINSTON
Credential	:	LPC
Telephone Number	:	719-350-6600

Provider Enumeration Date	:	09/14/2023
Last Update Date	:	02/02/2024

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