Organization
PROVIDENCE NETWORK
Active
Other names
The Executive Network
Organization subpart
No
Provider details
NPI number
Authorized official
DEREK KUYKENDALL (EXECUTIVE DIRECTOR)
(303) 860-8484
Entity
Organization
Contact information
Practice address
2544 CHAMPA ST, DENVER, CO 80205-3700
(303) 744-3986
Mailing address
801 N LOGAN ST, DENVER, CO 80203-3114
(303) 744-3986
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
03/14/2024
Last updated
03/14/2024
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