1184193757 NPI number — LIA SEDGELEY, LCSW, MAC, CACIII, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184193757 NPI number — LIA SEDGELEY, LCSW, MAC, CACIII, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIA SEDGELEY, LCSW, MAC, CACIII, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184193757
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11757 W. KEN CARYL AVE
Provider Second Line Business Mailing Address:
STE F#143
Provider Business Mailing Address City Name:
LITTLETON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80127-3719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-419-6146
Provider Business Mailing Address Fax Number:
303-474-6852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7475 W. 5TH AVE
Provider Second Line Business Practice Location Address:
STE 201B
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80226-1675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-419-6146
Provider Business Practice Location Address Fax Number:
303-474-6852
Provider Enumeration Date:
11/13/2018

Additional Information

Authorized Official

Authorized Official Last Name:
SEDGELEY
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
Authorized Official Title or Position:
THERAPIST/OWNER
Authorized Official Telephone Number:
303-419-6146

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9000155394 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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