Provider Demographics
NPI:1447883566
Name:MOUNT TABOR COUNSELING
Entity type:Organization
Organization Name:MOUNT TABOR COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BALKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-422-1567
Mailing Address - Street 1:12500 W 58TH AVE UNIT 211
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-1104
Mailing Address - Country:US
Mailing Address - Phone:303-422-1567
Mailing Address - Fax:
Practice Address - Street 1:5945 WARD RD STE 100
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-3901
Practice Address - Country:US
Practice Address - Phone:303-422-1567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-17
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty