Provider Demographics
NPI:1215759774
Name:CHILDREN'S TRAUMA CENTER, LLC
Entity type:Organization
Organization Name:CHILDREN'S TRAUMA CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:720-262-1279
Mailing Address - Street 1:26719 PLEASANT PARK RD
Mailing Address - Street 2:UNIT 120
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433
Mailing Address - Country:US
Mailing Address - Phone:720-262-1279
Mailing Address - Fax:
Practice Address - Street 1:295 5TH STREET
Practice Address - Street 2:SUITE 8
Practice Address - City:FAIRPLAY
Practice Address - State:CO
Practice Address - Zip Code:80440-5016
Practice Address - Country:US
Practice Address - Phone:720-262-1279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty