Provider Demographics
NPI:1285145300
Name:PIKES PEAK OS PLLC
Entity type:Organization
Organization Name:PIKES PEAK OS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:PARKOWSKI HELMER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:719-321-6254
Mailing Address - Street 1:PO BOX 9543
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80932-0543
Mailing Address - Country:US
Mailing Address - Phone:719-321-6254
Mailing Address - Fax:
Practice Address - Street 1:328 SWOPE AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5837
Practice Address - Country:US
Practice Address - Phone:719-321-6254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0010644101Y00000X
CO9923175104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty