Provider Demographics
NPI:1053177303
Name:VIDA CONSEJERIA INVIDUAL & FAMILIAR PLLC
Entity type:Organization
Organization Name:VIDA CONSEJERIA INVIDUAL & FAMILIAR PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIDIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PONCE OROZCO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:720-823-8340
Mailing Address - Street 1:151 HIDDEN OAKS RD
Mailing Address - Street 2:
Mailing Address - City:WIMBERLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78676-6220
Mailing Address - Country:US
Mailing Address - Phone:720-823-8340
Mailing Address - Fax:
Practice Address - Street 1:10465 MELODY DR
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-4119
Practice Address - Country:US
Practice Address - Phone:720-823-8340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty