| Original Path Counseling, Llc | |
|
6551 S Revere Pkwy Ste 160 Centennial CO 80111-6469 | |
| (720) 735-7444 | |
| Not Available |
| Full Name | Original Path Counseling, Llc |
|---|---|
| Speciality | Counselor |
| Location | 6551 S Revere Pkwy Ste 160, Centennial, Colorado |
| Authorized Official Name and Position | Amanda Horak (OWNER/ LPC) |
| Authorized Official Contact | 7207257444 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Original Path Counseling, Llc 6551 S Revere Pkwy Ste 160 Centennial CO 80111-6469 Ph: (720) 735-7444 | Original Path Counseling, Llc 6551 S Revere Pkwy Ste 160 Centennial CO 80111-6469 Ph: (720) 735-7444 |
| NPI Number | 1578064994 |
|---|---|
| Provider Enumeration Date | 02/21/2018 |
| Last Update Date | 03/31/2024 |
| Certification Date | 09/19/2023 |
| Medicare PECOS PAC ID | 1557709839 |
|---|---|
| Medicare Enrollment ID | O20240405000164 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578064994 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| Provider Name | Amanda Horak |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1871835801 PECOS PAC ID: 1355789637 Enrollment ID: I20240405000292 |
| Provider Name | Tracilyn Corindette Blackwell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1740934173 PECOS PAC ID: 1759720600 Enrollment ID: I20240411004143 |
| Provider Name | Tyler Andrew Lamy |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1831721042 PECOS PAC ID: 8325487093 Enrollment ID: I20240415000013 |
| Provider Name | Barbara Faulhaber Hernandez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235515750 PECOS PAC ID: 1153762695 Enrollment ID: I20240515000022 |
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