| Bristlecone Family Counseling | |
|
317 E Kiowa St Colorado Springs CO 80903-1712 | |
| (719) 661-9323 | |
| (719) 434-9930 |
| Full Name | Bristlecone Family Counseling |
|---|---|
| Speciality | Counselor |
| Location | 317 E Kiowa St, Colorado Springs, Colorado |
| Authorized Official Name and Position | Tamra Lee Bok (OWNER/OPERATOR) |
| Authorized Official Contact | 7192837990 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bristlecone Family Counseling 700 Valley View Dr Woodland Park CO 80863-8370 Ph: (719) 661-9323 | Bristlecone Family Counseling 317 E Kiowa St Colorado Springs CO 80903-1712 Ph: (719) 661-9323 |
| NPI Number | 1972049328 |
|---|---|
| Provider Enumeration Date | 01/10/2017 |
| Last Update Date | 10/07/2024 |
| Certification Date | 10/02/2024 |
| Medicare PECOS PAC ID | 9638500812 |
|---|---|
| Medicare Enrollment ID | O20200505000203 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972049328 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LPC.0012459 (Colorado) | Primary |
| Provider Name | Cheryl A Baeza |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477754125 PECOS PAC ID: 2860412699 Enrollment ID: I20051123000063 |
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