Provider Demographics
NPI:1447982616
Name:MISFIT ADDICTION COUNSELING
Entity type:Organization
Organization Name:MISFIT ADDICTION COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ LEAD COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:MA CAS
Authorized Official - Phone:970-403-5198
Mailing Address - Street 1:12300 HIGHWAY 491
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-9398
Mailing Address - Country:US
Mailing Address - Phone:970-403-5198
Mailing Address - Fax:
Practice Address - Street 1:12300 HIGHWAY 491
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-9398
Practice Address - Country:US
Practice Address - Phone:970-403-5198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-27
Last Update Date:2024-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty