Provider Demographics
NPI:1144828435
Name:HEADWATERS COUNSELING LLC
Entity type:Organization
Organization Name:HEADWATERS COUNSELING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:SUNDQUIST
Authorized Official - Last Name:JOSE
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC RPT-S
Authorized Official - Phone:303-393-0085
Mailing Address - Street 1:899 N LOGAN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-3155
Mailing Address - Country:US
Mailing Address - Phone:303-429-5099
Mailing Address - Fax:303-432-6190
Practice Address - Street 1:8089 S LINCOLN ST STE 206
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2720
Practice Address - Country:US
Practice Address - Phone:303-429-5099
Practice Address - Fax:303-432-6190
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEADWATERS COUNSELING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-09
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000178385Medicaid