Provider Demographics
NPI:1396500153
Name:SELF CARE IMPACT COUNSELING LLC
Entity type:Organization
Organization Name:SELF CARE IMPACT COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILLOD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:720-551-4553
Mailing Address - Street 1:12211 W ALAMEDA PKWY STE 106
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-2867
Mailing Address - Country:US
Mailing Address - Phone:720-551-4553
Mailing Address - Fax:
Practice Address - Street 1:12211 W ALAMEDA PKWY STE 106
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-2867
Practice Address - Country:US
Practice Address - Phone:720-551-4553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)