Basic Information
| Provider Information | |||||||||
| NPI: | 1356478853 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LONGORIA | ||||||||
| FirstName: | DENNISHA | ||||||||
| MiddleName: | BERNELL | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | B.A. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BARNUM | ||||||||
| OtherFirstName: | DENNISHA | ||||||||
| OtherMiddleName: | BERNELL | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1705 S 13TH ST | ||||||||
| Address2: | |||||||||
| City: | LAMAR | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810524015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193360828 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3500 1ST STREET SOUTH | ||||||||
| Address2: | |||||||||
| City: | LAMAR | ||||||||
| State: | CO | ||||||||
| PostalCode: | 81052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193367501 | ||||||||
| FaxNumber: | 7193367453 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.