| Elephant In The Room Llc | |
|
7596 W Jewell Ave # 1-202 Lakewood CO 80232-6889 | |
| (720) 310-6713 | |
| (844) 412-7875 |
| Full Name | Elephant In The Room Llc |
|---|---|
| Speciality | Counselor |
| Location | 7596 W Jewell Ave # 1-202, Lakewood, Colorado |
| Authorized Official Name and Position | Zina Ortiz (CEO) |
| Authorized Official Contact | 7203106710 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elephant In The Room Llc 7596 W Jewell Ave # 1-202 Lakewood CO 80232-6889 Ph: (720) 310-6713 | Elephant In The Room Llc 7596 W Jewell Ave # 1-202 Lakewood CO 80232-6889 Ph: (720) 310-6713 |
| NPI Number | 1063877306 |
|---|---|
| Provider Enumeration Date | 12/30/2015 |
| Last Update Date | 03/15/2024 |
| Certification Date | 03/15/2024 |
| Medicare PECOS PAC ID | 8123470861 |
|---|---|
| Medicare Enrollment ID | O20240118002772 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063877306 | NPI | - | NPPES |
| 98870076 | Medicaid | CO | |
| 17687543 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Zina Ortiz |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1871790295 PECOS PAC ID: 6002259025 Enrollment ID: I20240207001493 |
| Provider Name | Constantina Christina Costalas |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1326814609 PECOS PAC ID: 6800239856 Enrollment ID: I20240207001913 |
| Provider Name | Ulysses Diaz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629708961 PECOS PAC ID: 0345683215 Enrollment ID: I20240207002770 |
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