Collaborative Service for Change PC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

992298 Issued in CO

Legal business name

COLLABORATIVE SERVICE FOR CHANGE PC

Practice address

2480 W 26TH Ave
Suite 130B
Denver, CO 80211-5309

Phone

(303) 433-0188

Fax

(303) 433-6145

NPI assigned

Aug 9, 2016

Last updated

Aug 9, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jeff Richard Kisicki, LCSWNPI 1447499595

Title

Executive Director

Phone

(303) 433-0188

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jeff R Kisicki, LCSW

  • Specialist
  • Denver, CO
  • NPI 1447499595
  NPD (past) Authorized official
• Marci Mandel Brewer, MSW, LCSW

  • Clinical Social Worker
  • Denver, CO
  • NPI 1689894545
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1470700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470700800000",
    "number": "1902350788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2480 W 26TH AVE",
            "address_2": "SUITE 130B",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802115309",
            "telephone_number": "303-433-0188",
            "fax_number": "303-433-6145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2480 W 26TH AVE",
            "address_2": "SUITE 130B",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802115309",
            "telephone_number": "303-433-0188",
            "fax_number": "303-433-6145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLABORATIVE SERVICE FOR CHANGE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-09",
        "last_updated": "2016-08-09",
        "status": "A",
        "authorized_official_last_name": "KISICKI",
        "authorized_official_first_name": "JEFF",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "303-433-0188",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "CO",
            "license": "992298",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42427851",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kira Gangsei Colgan, LMFT
• Bryant Colie
• Claire Love Colie
• Collaborative Center, LLC
• Collaborative Counseling
• Eric Collard
• Collective Counseling Solutions LLC
• Colleen Attoma Mathews Inc
• Colleen M. Laine and Associates Inc.
• Colleen S. Carter DDS, PC

• Community/Behavioral Health Agency in Denver, CO
• Providers in Denver, CO by specialty
• Community/Behavioral Health Agency in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.