1417962234 NPI number — SAMARITAN COUNSELING CENTER

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 1417962234 NPI number — SAMARITAN COUNSELING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAMARITAN COUNSELING CENTER
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:
CENTUS COUNSELING
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:
1417962234
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7887 EAST BELLEVIEW AVENUE
Provider Second Line Business Mailing Address:
SUITE 1100
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80111-6097
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-639-5240
Provider Business Mailing Address Fax Number:
303-639-5243

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7887 EAST BELLEVIEW AVENUE
Provider Second Line Business Practice Location Address:
SUITE 1100
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80111-6097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-639-5240
Provider Business Practice Location Address Fax Number:
303-639-5243
Provider Enumeration Date:
07/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRETZ
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
303-639-5240

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  20061225881 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 10326871 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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