MEDICARE: RIVER COMMUNITY COUNSELING CENTER

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	:	1861136541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER COMMUNITY COUNSELING CENTER

Provider Business Mailing Address
First Line	:	220 S YARROW ST
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-1528
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 S YARROW ST
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-1528
Country	:	US
Telephone Number	:	720-296-0049
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	ANGELA DOUGLAS
Credential	:	MA, LPC, NBCC
Telephone Number	:	720-442-0031

Provider Enumeration Date	:	04/27/2022
Last Update Date	:	12/29/2022

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Directions to “RIVER COMMUNITY COUNSELING CENTER ” Practice Location

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