Basic Information
| Provider Information | |||||||||
| NPI: | 1063749166 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BABANI | ||||||||
| FirstName: | CARLEEN | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 RUSKIN DR | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809102522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195726100 | ||||||||
| FaxNumber: | 7195726080 | ||||||||
| Practice Location | |||||||||
| Address1: | 460 COUNTY ROAD 43 | ||||||||
| Address2: | STE 7 | ||||||||
| City: | BAILEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804212503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195726330 | ||||||||
| FaxNumber: | 7195726089 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2009 | ||||||||
| LastUpdateDate: | 11/10/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 1142 | CO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.