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104 S. Main St Suite 3 Mancos CO 81328 | |
| (970) 403-5488 | |
| (970) 422-7236 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 104 S. Main St, Mancos, Colorado |
| Authorized Official Name and Position | David Cole Awdish (OWNER/OPERATOR) |
| Authorized Official Contact | 9704035488 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
844 Bauer Ave Mancos CO 81328-9255 Ph: (970) 403-5488 | 104 S. Main St Suite 3 Mancos CO 81328 Ph: (970) 403-5488 |
| NPI Number | 1215446612 |
|---|---|
| Provider Enumeration Date | 09/28/2017 |
| Last Update Date | 06/06/2024 |
| Certification Date | 05/29/2024 |
| Medicare PECOS PAC ID | 6901341023 |
|---|---|
| Medicare Enrollment ID | O20240712004050 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215446612 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 0013328 (Colorado) | Primary |
| Provider Name | David Cole Awdish |
|---|---|
| Provider Type | Practitioner - Other (non-physician) |
| Provider Identifiers | NPI Number: 1174929558 PECOS PAC ID: 7719422831 Enrollment ID: I20240712004067 |
| Provider Name | Danielle Dipiro |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1184473019 PECOS PAC ID: 6305370925 Enrollment ID: I20241105002509 |
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