# PROVIDENCE NETWORK

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Executive Network
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972362788
- **Authorized official:** DEREK KUYKENDALL (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (303) 860-8484

## Contact information

- **Practice address:** 2330 N WASHINGTON ST, DENVER, CO 80205-3266
- **Practice address phone:** (303) 744-3986
- **Mailing address:** 801 N LOGAN ST, DENVER, CO 80203-3114
- **Mailing address phone:** (303) 744-3986

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | Yes |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | Yes |

## Other

- **Enumeration date:** 03/14/2024
- **Last updated:** 03/14/2024