Provider Demographics
NPI:1306090758
Name:THE PARENT-CHILD INTERACTION CENTER LLC
Entity type:Organization
Organization Name:THE PARENT-CHILD INTERACTION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:THERESE
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:970-472-1207
Mailing Address - Street 1:375 E HORSETOOTH RD
Mailing Address - Street 2:BLDG 3 SUITE 101
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3155
Mailing Address - Country:US
Mailing Address - Phone:970-472-1207
Mailing Address - Fax:970-493-1305
Practice Address - Street 1:375 E HORSETOOTH RD
Practice Address - Street 2:BLDG 3 SUITE 101
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3155
Practice Address - Country:US
Practice Address - Phone:970-472-1207
Practice Address - Fax:970-493-1305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4838101YP2500X
CO806106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty