Individual
MR. FREDERICK ELIAS PERSIKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M DIV., CACITI
Contact information
Practice address
23400 TWO RIVERS ROAD, #49, BASALT, CO 81621
(970) 927-5357
(970) 927-3467
Mailing address
P.O. BOX 138, BASALT, CO 81621
(970) 927-5357
(970) 927-3467
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
2810
CO
104100000X
Social Worker
Primary
6807010854
MI
Other
Enumeration date
03/09/2009
Last updated
03/09/2009
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