Provider Demographics
NPI:1447475280
Name:INSIDE OUT COUNSELING PC
Entity type:Organization
Organization Name:INSIDE OUT COUNSELING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:DENGLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, PHD
Authorized Official - Phone:717-250-9569
Mailing Address - Street 1:PO BOX 7567
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-0567
Mailing Address - Country:US
Mailing Address - Phone:719-250-9569
Mailing Address - Fax:719-547-7869
Practice Address - Street 1:44 E SPAULDING AVE
Practice Address - Street 2:BUILDING 3, SUITE 1
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-1668
Practice Address - Country:US
Practice Address - Phone:719-250-9569
Practice Address - Fax:719-547-7869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9916181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO152760Medicaid
CO31526Medicare ID - Type Unspecified