Provider Demographics
NPI:1215503776
Name:CONNECT COUNSELING & PSYCHOLOGICAL SERVICES, PLLC
Entity type:Organization
Organization Name:CONNECT COUNSELING & PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:MAYUMI
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:719-370-3839
Mailing Address - Street 1:430 BEACON LITE ROAD
Mailing Address - Street 2:UNIT 140
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132
Mailing Address - Country:US
Mailing Address - Phone:719-370-3839
Mailing Address - Fax:
Practice Address - Street 1:430 BEACON LITE RD UNIT 140
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9146
Practice Address - Country:US
Practice Address - Phone:719-370-3839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-03
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty