MEDICARE: VANDA COUNSELING COLLABORATIVE

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	:	1790516961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANDA COUNSELING COLLABORATIVE

Provider Business Mailing Address
First Line	:	1542 ELM ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-1241
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1542 ELM ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-1241
Country	:	US
Telephone Number	:	720-277-9356
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOSE TAPIA
Credential	:
Telephone Number	:	720-277-9356

Provider Enumeration Date	:	08/09/2024
Last Update Date	:	08/09/2024

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