Organization
CHIPITA COUNSELING SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARYANN K LONGWELL LCSW (OWNER)
(719) 329-4810
Entity
Organization
Contact information
Practice address
1548 G ST, SUITE 2A, SALIDA, CO 81201-2645
(719) 329-4810
(866) 805-1874
Mailing address
1548 G ST, SUITE 2A, SALIDA, CO 81201-2645
(719) 329-4810
(866) 805-1874
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1159
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
69200084
—
CO
01
—
COA 103565
MEDICARE PROVIDER TRANSACTION ACCESS NUMBER
CO
Enumeration date
06/28/2013
Last updated
06/28/2013
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