Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 6167 | CO |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ACC-6167 | CO |
N | 101YP2500X | Professional Counselor | 3151 | CO |
Y | 101YP2500X | Professional Counselor | LPC-3151 | CO |
NPI | 1003959651 |
---|---|
Provider Name | Mrs. Tracy Jones Kinsley |
First Address | Colorado Springs, CO 80904-3840 |
Second Address | Colorado Springs, CO 80904-3840 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 12/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
476195 | (05) | CO |