1043753734 NPI number — AN INTUITIVE MIND COUNSELING CONSULTING & PSYCHOLOGICAL SERVICE

Table of content: (NPI 1043753734)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043753734 NPI number — AN INTUITIVE MIND COUNSELING CONSULTING & PSYCHOLOGICAL SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AN INTUITIVE MIND COUNSELING CONSULTING & PSYCHOLOGICAL SERVICE
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:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1043753734
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12835 EAST ARAPAHOE RD
Provider Second Line Business Mailing Address:
TOWER II, SUITE 440
Provider Business Mailing Address City Name:
CENTENNIAL
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80112-4037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-984-0244
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12835 EAST ARAPAHOE RD
Provider Second Line Business Practice Location Address:
TOWER II, SUITE 440
Provider Business Practice Location Address City Name:
CENTENNIAL
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80112-4037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-984-0244
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/29/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WILLSON
Authorized Official First Name:
BRYCE
Authorized Official Middle Name:
CRAIG
Authorized Official Title or Position:
PSYCHOLOGIST/OWNER
Authorized Official Telephone Number:
720-984-0244

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  3874 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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