MEDICARE: ALL TERRAIN BEHAVIOR HEALTH GROUP

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
2	251S00000X	Community/Behavioral Health Agency	MFT.0001180	CO
3	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1831678796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL TERRAIN BEHAVIOR HEALTH GROUP

Provider Business Mailing Address
First Line	:	6805 CORPORATE DRIVE
Second Line	:	SUITE 120
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-1977
Country	:	US
Telephone Number	:	719-726-8811
Fax Number	:	719-631-0699

Provider Business Practice Location Address
First Line	:	6805 CORPORATE DRIVE
Second Line	:	SUITE 120
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-1977
Country	:	US
Telephone Number	:	719-726-8811
Fax Number	:	719-631-0699

Authorized Official
Title or Position	:	OPERATIONS DIRECTOR
Name	:	AUTUMNE GOOD
Credential	:	LPC
Telephone Number	:	719-695-0397

Provider Enumeration Date	:	08/11/2018
Last Update Date	:	03/02/2022

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