Provider Demographics
NPI:1942770318
Name:RELATE FAMILY THERAPY AND COUNSELING, LLC
Entity type:Organization
Organization Name:RELATE FAMILY THERAPY AND COUNSELING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JASMYNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KETTWICK
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, RPT, CSST
Authorized Official - Phone:303-954-9809
Mailing Address - Street 1:12835 E ARAPAHOE RD # 2-410
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3940
Mailing Address - Country:US
Mailing Address - Phone:303-954-9809
Mailing Address - Fax:
Practice Address - Street 1:12835 E ARAPAHOE RD # 2-410
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3940
Practice Address - Country:US
Practice Address - Phone:303-954-9809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-28
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000175235Medicaid