Basic Information
| Provider Information | |||||||||
| NPI: | 1003291048 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SALAZAR | ||||||||
| FirstName: | PEGGY | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SALAZAR | ||||||||
| OtherFirstName: | PEGGY | ||||||||
| OtherMiddleName: | A, | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MA, LPCC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5650 GREENWOOD PLAZA BLVD STE 202 | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801112309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035030372 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5650 GREENWOOD PLAZA BLVD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801112307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035030372 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2015 | ||||||||
| LastUpdateDate: | 07/20/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 921637120 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.