| Sacred Self Counseling, Llc | |
|
107 S 9th St Canon City CO 81212-3800 | |
| (719) 221-0959 | |
| Not Available |
| Full Name | Sacred Self Counseling, Llc |
|---|---|
| Speciality | Counselor |
| Location | 107 S 9th St, Canon City, Colorado |
| Authorized Official Name and Position | Alyssa Klugh (OWNER) |
| Authorized Official Contact | 7192210959 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sacred Self Counseling, Llc 921 Barr Ave Canon City CO 81212-2131 Ph: (719) 221-0959 | Sacred Self Counseling, Llc 107 S 9th St Canon City CO 81212-3800 Ph: (719) 221-0959 |
| NPI Number | 1710614102 |
|---|---|
| Provider Enumeration Date | 08/04/2022 |
| Last Update Date | 08/16/2022 |
| Certification Date | 08/16/2022 |
| Medicare PECOS PAC ID | 6901242775 |
|---|---|
| Medicare Enrollment ID | O20240314003826 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710614102 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Alyssa Klugh |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1255618344 PECOS PAC ID: 1355794280 Enrollment ID: I20240126004084 |
| Provider Name | Michele Nielle Wilson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1396349916 PECOS PAC ID: 2668816059 Enrollment ID: I20240213003685 |
| Provider Name | Trinda Hosselkus |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1861911315 PECOS PAC ID: 8123462017 Enrollment ID: I20240219003515 |
| Provider Name | Tina Lorraine Bezona |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1003031287 PECOS PAC ID: 4183062185 Enrollment ID: I20240410001742 |
| Provider Name | Jamie Soucie |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1396102794 PECOS PAC ID: 7012459639 Enrollment ID: I20240611000032 |
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