Basic Information
Provider Information | |||||||||
NPI: | 1306492780 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | MILE HIGH COUNSELING AND CONSULTING, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1250 S PARKER RD STE 202 | ||||||||
Address2: |   | ||||||||
City: | DENVER | ||||||||
State: | CO | ||||||||
PostalCode: | 802312178 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3036417617 | ||||||||
FaxNumber: | 8666888087 | ||||||||
Practice Location | |||||||||
Address1: | 1250 S PARKER RD STE 202 | ||||||||
Address2: |   | ||||||||
City: | DENVER | ||||||||
State: | CO | ||||||||
PostalCode: | 802312178 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3036417617 | ||||||||
FaxNumber: | 8666888087 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/12/2019 | ||||||||
LastUpdateDate: | 08/12/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | GEARHART | ||||||||
AuthorizedOfficialFirstName: | KRISTIN | ||||||||
AuthorizedOfficialMiddleName: | NICOLE | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER/CLINICIAN | ||||||||
AuthorizedOfficialTelephone: | 3036417617 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MA, LPC | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.