1134331903 NPI number — KRUPNICK COUNSELING ASSOCIATES PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134331903 NPI number — KRUPNICK COUNSELING ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KRUPNICK COUNSELING ASSOCIATES PC
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:
LONGMONT EMPLOYEE ASSISTANCE PROGRAM
Provider Other Organization Name Type Code:
3
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:
1134331903
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 KIMBARK ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
LONGMONT
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80501-5583
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-651-1515
Provider Business Mailing Address Fax Number:
720-652-0408

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 KIMBARK ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
LONGMONT
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80501-5583
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-651-1515
Provider Business Practice Location Address Fax Number:
720-652-0408
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GRIEGO
Authorized Official First Name:
KEHLE
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS DEVELOPMENT DIRECTOR
Authorized Official Telephone Number:
303-651-1515

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X , with the licence number:  1832 , 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)





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