Organization
COLLABORATIVE SERVICE FOR CHANGE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF RICHARD KISICKI LCSW (EXECUTIVE DIRECTOR)
(303) 433-0188
Entity
Organization
Contact information
Practice address
2480 W 26TH AVE, SUITE 130B, DENVER, CO 80211-5309
(303) 433-0188
(303) 433-6145
Mailing address
2480 W 26TH AVE, SUITE 130B, DENVER, CO 80211-5309
(303) 433-0188
(303) 433-6145
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
992298
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42427851
—
CO
Enumeration date
08/09/2016
Last updated
08/09/2016
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