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NPI Code Detail

MEDICARE: GUIDED WATERS COUNSELING, LLC

MEDICARE: GUIDED WATERS COUNSELING, 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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1831780808
Entity Type Code : Organization
Provider Name (Legal Business Name) : GUIDED WATERS COUNSELING, LLC
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 : 719-649-9778
Fax Number : 719-368-6485
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 : 719-649-9778
Fax Number :
Authorized Official
Title or Position : BEHAVIORAL THERAPIST
Name : HEATHER ALLEN
Credential : LCSW
Telephone Number : 719-649-9778
Provider Enumeration Date : 02/01/2021
Last Update Date : 04/01/2022

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Directions to “GUIDED WATERS COUNSELING, LLC ” Practice Location

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