Provider Demographics
NPI:1679803993
Name:SAFESIDE COUNSELING, LLC
Entity type:Organization
Organization Name:SAFESIDE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANAE
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:719-244-3662
Mailing Address - Street 1:PO BOX 1085
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-1085
Mailing Address - Country:US
Mailing Address - Phone:719-244-3662
Mailing Address - Fax:
Practice Address - Street 1:2993 BROADMOOR VALLEY RD
Practice Address - Street 2:SUITE 105C
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4471
Practice Address - Country:US
Practice Address - Phone:719-244-3662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)