Provider Demographics
NPI:1053708883
Name:NORTHERN COLORADO DIALECTICAL BEHAVIOR THERAPY, LLC
Entity type:Organization
Organization Name:NORTHERN COLORADO DIALECTICAL BEHAVIOR THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COCHRAN-WARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:970-443-0846
Mailing Address - Street 1:1031 ROBERTSON ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3926
Mailing Address - Country:US
Mailing Address - Phone:970-443-0846
Mailing Address - Fax:970-493-9113
Practice Address - Street 1:1031 ROBERTSON ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3926
Practice Address - Country:US
Practice Address - Phone:970-443-0846
Practice Address - Fax:970-493-9113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-20
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW000003291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty