Basic Information
| Provider Information | |||||||||
| NPI: | 1932617792 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WHOLE KIDS CO. PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11681 VOYAGER PKWY STE 150 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809213864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193449342 | ||||||||
| FaxNumber: | 7193753531 | ||||||||
| Practice Location | |||||||||
| Address1: | 11681 VOYAGER PKWY STE 150 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809213864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193449342 | ||||||||
| FaxNumber: | 7193753531 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2018 | ||||||||
| LastUpdateDate: | 04/19/2021 | ||||||||
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| AuthorizedOfficialLastName: | COLLINS | ||||||||
| AuthorizedOfficialFirstName: | CHRISTIE | ||||||||
| AuthorizedOfficialMiddleName: | GAIL | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER AND CLINICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4692231579 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MA, LPC, BCBA | ||||||||
| NPICertificationDate: | 04/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-16-22433 | CO | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst | 101YP2500X | 0013986 | CO | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 00684210 | 05 | CO | MEDICAID |