Provider Demographics
NPI:1487364139
Name:THE LIBERATION COALITION
Entity type:Organization
Organization Name:THE LIBERATION COALITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON MARTONE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:719-271-2764
Mailing Address - Street 1:1797 ALTON ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80010-1716
Mailing Address - Country:US
Mailing Address - Phone:719-271-2764
Mailing Address - Fax:
Practice Address - Street 1:121 S MADISON ST STE D
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010
Practice Address - Country:US
Practice Address - Phone:719-271-2764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-02
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty