1396090593 NPI number — FAMILY INTEGRATION COUNSELING SERVICE, INC.

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 1396090593 NPI number — FAMILY INTEGRATION COUNSELING SERVICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY INTEGRATION COUNSELING SERVICE, 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:
1396090593
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60615 US HIGHWAY 285
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAILEY
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-838-5406
Provider Business Mailing Address Fax Number:
888-805-4990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60615 US HIGHWAY 285
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAILEY
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-838-5406
Provider Business Practice Location Address Fax Number:
888-805-4990
Provider Enumeration Date:
07/13/2012

Additional Information

Authorized Official

Authorized Official Last Name:
POWELL
Authorized Official First Name:
DUSTIN
Authorized Official Middle Name:
TED
Authorized Official Title or Position:
OWNER/PSYCHOTHERAPIST
Authorized Official Telephone Number:
303-838-5406

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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