1477700565 NPI number — CANON CITY COUNSELING, INC

Table of content: (NPI 1477700565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477700565 NPI number — CANON CITY COUNSELING, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CANON CITY COUNSELING, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477700565
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
224 N COTTONWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANON CITY
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81212-2507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-276-0292
Provider Business Mailing Address Fax Number:
719-276-0292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
224 N COTTONWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANON CITY
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81212-2507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-276-0292
Provider Business Practice Location Address Fax Number:
719-276-0292
Provider Enumeration Date:
08/20/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHAPMAN
Authorized Official First Name:
SALLY
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
719-276-0292

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  5044 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: 6391 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 2425 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YP2500X , with the licence number: 3037 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)