| Pine Grove Counseling Center Llc | |
|
1942 Broadway Ste 314c Boulder CO 80302 | |
| (443) 834-6960 | |
| Not Available |
| Full Name | Pine Grove Counseling Center Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1942 Broadway Ste 314c, Boulder, Colorado |
| Authorized Official Name and Position | Lydia Shannon (OWNER) |
| Authorized Official Contact | 4438346960 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pine Grove Counseling Center Llc 9249 S Broadway Unit 200 Highlands Ranch CO 80129-5692 Ph: () - | Pine Grove Counseling Center Llc 1942 Broadway Ste 314c Boulder CO 80302 Ph: (443) 834-6960 |
| NPI Number | 1255080628 |
|---|---|
| Provider Enumeration Date | 03/22/2022 |
| Last Update Date | 03/24/2022 |
| Certification Date | 03/24/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255080628 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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