Provider Demographics
NPI:1700112653
Name:COLORADO COUNSELING AND CONSULTING SERVICES
Entity type:Organization
Organization Name:COLORADO COUNSELING AND CONSULTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIRWAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:719-444-0250
Mailing Address - Street 1:2790 N ACADEMY BLVD STE 312
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5347
Mailing Address - Country:US
Mailing Address - Phone:719-444-0250
Mailing Address - Fax:719-444-0253
Practice Address - Street 1:2790 N ACADEMY BLVD STE 312
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5347
Practice Address - Country:US
Practice Address - Phone:719-444-0250
Practice Address - Fax:719-444-0253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO398106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty