Basic Information
| Provider Information | |||||||||
| NPI: | 1164032827 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KIDSTUFF CHILD AND FAMILY COUNSELING, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1140 W. 29TH ST. | ||||||||
| Address2: | STE. 100 | ||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9707757061 | ||||||||
| FaxNumber: | 9702928194 | ||||||||
| Practice Location | |||||||||
| Address1: | 360 15TH AVE | ||||||||
| Address2: | STE. 104 | ||||||||
| City: | LONGMONT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9707757061 | ||||||||
| FaxNumber: | 9702928194 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2020 | ||||||||
| LastUpdateDate: | 08/06/2020 | ||||||||
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| AuthorizedOfficialLastName: | UNDERWOOD BRUNTZ | ||||||||
| AuthorizedOfficialFirstName: | LAURIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3035327260 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 103TC0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical | 1041C0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YP2500X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 52105083 | 05 | CO | MEDICAID |