Provider Demographics
NPI:1992329189
Name:COLORADO CHRISTIAN UNIVERSITY COMMUNITY COUNSELING CENTER
Entity type:Organization
Organization Name:COLORADO CHRISTIAN UNIVERSITY COMMUNITY COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TRENTON
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:LANGHOFER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:316-992-3062
Mailing Address - Street 1:1125 KELLY JOHNSON BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3982
Mailing Address - Country:US
Mailing Address - Phone:719-867-5805
Mailing Address - Fax:
Practice Address - Street 1:1125 KELLY JOHNSON BLVD STE 140
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3982
Practice Address - Country:US
Practice Address - Phone:719-867-5805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLORADO CHRISTIAN UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-03
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health