Provider Demographics
NPI:1528609674
Name:COURAGEOUS COUNSELING COLORADO, PLLC
Entity type:Organization
Organization Name:COURAGEOUS COUNSELING COLORADO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-503-5906
Mailing Address - Street 1:8120 SHERIDAN BLVD STE 334C
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80003-6165
Mailing Address - Country:US
Mailing Address - Phone:720-503-5906
Mailing Address - Fax:
Practice Address - Street 1:8120 SHERIDAN BLVD STE 334C
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80003-6165
Practice Address - Country:US
Practice Address - Phone:720-503-5906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000171890Medicaid