Basic Information
| Provider Information | |||||||||
| NPI: | 1124251889 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | AARON | ||||||||
| MiddleName: | I | ||||||||
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| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12050 N PECOS ST | ||||||||
| Address2: | STE #170 | ||||||||
| City: | WESTMINSTER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7206488285 | ||||||||
| FaxNumber: | 7208081594 | ||||||||
| Practice Location | |||||||||
| Address1: | 12050 N PECOS ST | ||||||||
| Address2: | STE #170 | ||||||||
| City: | WESTMINSTER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7206488285 | ||||||||
| FaxNumber: | 7208081594 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2009 | ||||||||
| LastUpdateDate: | 01/30/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 8966 | NE | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | 13699 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 13699 | 01 | CO | CO MENTAL HEALTH BOARD | OTHER | 8966 | 01 | NE | NE LICENSE | OTHER |