Basic Information
| Provider Information | |||||||||
| NPI: | 1235770546 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEART CENTERED COUNSELING PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 320 W OLIVE ST | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805212716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703103406 | ||||||||
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| Practice Location | |||||||||
| Address1: | 410 S WILCOX ST STE 102 | ||||||||
| Address2: | |||||||||
| City: | CASTLE ROCK | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801042663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703103406 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2019 | ||||||||
| LastUpdateDate: | 01/15/2021 | ||||||||
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| AuthorizedOfficialLastName: | GUZZO | ||||||||
| AuthorizedOfficialFirstName: | SIRIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 9703103406 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical | 1041C0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 2084P0800X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 363LP0808X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 101YP2500X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.