| Primary Witness | |
|
1574 York St Ste 101 Denver CO 80206-1248 | |
| (303) 875-0145 | |
| Not Available |
| Full Name | Primary Witness |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1574 York St Ste 101, Denver, Colorado |
| Authorized Official Name and Position | Thiago Leao (OWNER) |
| Authorized Official Contact | 3038750145 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary Witness 1055 N Logan St Apt 1206 Denver CO 80203-3040 Ph: (303) 875-0145 | Primary Witness 1574 York St Ste 101 Denver CO 80206-1248 Ph: (303) 875-0145 |
| NPI Number | 1477175701 |
|---|---|
| Provider Enumeration Date | 05/08/2020 |
| Last Update Date | 05/08/2020 |
| Certification Date | 05/08/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477175701 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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