Provider Demographics
NPI:1427739473
Name:COLLEGIATE PEAKS COUNSELING, LLC
Entity type:Organization
Organization Name:COLLEGIATE PEAKS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:V
Authorized Official - Last Name:PAPATHAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:719-398-1167
Mailing Address - Street 1:PO BOX 1620
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-1648
Mailing Address - Country:US
Mailing Address - Phone:719-398-1167
Mailing Address - Fax:
Practice Address - Street 1:245 E HWY 50 STE 10
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2519
Practice Address - Country:US
Practice Address - Phone:719-398-1167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty