Provider Demographics
NPI:1174748008
Name:LIGHT OF THE ROCKIES CHRISTIAN COUNSELING CENTER
Entity type:Organization
Organization Name:LIGHT OF THE ROCKIES CHRISTIAN COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-484-1735
Mailing Address - Street 1:375 E HORSETOOTH RD BLDG 2101
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3196
Mailing Address - Country:US
Mailing Address - Phone:970-484-1735
Mailing Address - Fax:970-224-4893
Practice Address - Street 1:375 E HORSETOOTH RD BLDG 2101
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3196
Practice Address - Country:US
Practice Address - Phone:970-484-1735
Practice Address - Fax:970-224-4893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
CO940101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty