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12211 W Alameda Pkwy Ste 105 Lakewood CO 80228-2825 | |
| (303) 895-7204 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 12211 W Alameda Pkwy Ste 105, Lakewood, Colorado |
| Authorized Official Name and Position | Elizabeth Wagner (OWNER) |
| Authorized Official Contact | 3038957204 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
12211 W Alameda Pkwy Ste 105 Lakewood CO 80228-2825 Ph: (303) 895-7204 | 12211 W Alameda Pkwy Ste 105 Lakewood CO 80228-2825 Ph: (303) 895-7204 |
| NPI Number | 1952017337 |
|---|---|
| Provider Enumeration Date | 01/27/2023 |
| Last Update Date | 06/15/2023 |
| Certification Date | 06/15/2023 |
| Medicare PECOS PAC ID | 0042756173 |
|---|---|
| Medicare Enrollment ID | O20240724003360 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952017337 | NPI | - | NPPES |
| Provider Name | Elizabeth M Wagner |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1083949945 PECOS PAC ID: 8224570445 Enrollment ID: I20240604000355 |
| Provider Name | Susan Marie Newman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487805776 PECOS PAC ID: 5496287088 Enrollment ID: I20241021003667 |
| Provider Name | Mary Dominguez |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1891520169 PECOS PAC ID: 3577097161 Enrollment ID: I20241105001143 |
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