1891148458 NPI number — DANDELION PSYCHOLOGY, LLC

Table of content: (NPI 1891148458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891148458 NPI number — DANDELION PSYCHOLOGY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANDELION PSYCHOLOGY, 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:
1891148458
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9930 W 105TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTMINSTER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80021-7324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-704-3612
Provider Business Mailing Address Fax Number:
512-597-2829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7850 VANCE DR STE 185
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARVADA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80003-2127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-704-3612
Provider Business Practice Location Address Fax Number:
512-597-2829
Provider Enumeration Date:
07/19/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PETERS
Authorized Official First Name:
BETH
Authorized Official Middle Name:
RENAE
Authorized Official Title or Position:
FOUNDER AND PSYCHOLOGIST
Authorized Official Telephone Number:
303-704-3612

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  4004 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC2200X , with the licence number: 4004 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TF0000X , with the licence number: 4004 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 09923708 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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