Provider Demographics
NPI:1306302245
Name:GROWTH-CHANGE-REFLECTION COUNSELING AND CONSULTING LLC
Entity type:Organization
Organization Name:GROWTH-CHANGE-REFLECTION COUNSELING AND CONSULTING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER-ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:W
Authorized Official - Last Name:LAVOO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC, LAC
Authorized Official - Phone:719-298-3343
Mailing Address - Street 1:6660 DELMONICO DR STE D210
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1899
Mailing Address - Country:US
Mailing Address - Phone:719-641-6240
Mailing Address - Fax:303-532-5079
Practice Address - Street 1:7660 GODDARD ST STE 234
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-8231
Practice Address - Country:US
Practice Address - Phone:719-298-3343
Practice Address - Fax:303-532-5079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-15
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO28632508Medicaid