Organization
BEHAVIORAL CLINICAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADRIENNE C. WITHROW (OFFICE MANAGER)
(970) 241-6500
Entity
Organization
Contact information
Practice address
1005 N 12TH ST STE 105, GRAND JUNCTION, CO 81501-3156
(970) 241-6500
(970) 243-8835
Mailing address
1005 N 12TH ST STE 105, GRAND JUNCTION, CO 81501-3156
(970) 241-6500
(970) 243-8835
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
5607
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C801557
MEDICARE PROVIDER #C801557
CO
Enumeration date
12/02/2010
Last updated
12/02/2010
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