Basic Information
| Provider Information | |||||||||
| NPI: | 1578974945 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KIDSTUFF CHILD & FAMILY COUNSELING, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1440 W. 29TH ST. | ||||||||
| Address2: | STE. 100 | ||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805382402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9707757061 | ||||||||
| FaxNumber: | 9702928194 | ||||||||
| Practice Location | |||||||||
| Address1: | 1440 W. 29TH ST. | ||||||||
| Address2: | STE. 100 | ||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805382402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9707757061 | ||||||||
| FaxNumber: | 9702928194 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2014 | ||||||||
| LastUpdateDate: | 09/11/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | UNDERWOOD BRUNTZ | ||||||||
| AuthorizedOfficialFirstName: | LAURIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 3035327260 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LPC | ||||||||
| NPICertificationDate: | 09/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 4861 | CO | N | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional | 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 | 106H00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YP2500X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 43225764 | 05 | CO | MEDICAID | 19780524 | 05 | CO | MEDICAID |