Basic Information
| Provider Information | |||||||||
| NPI: | 1467967000 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEYO-BUNDY | ||||||||
| FirstName: | COURTNEY | ||||||||
| MiddleName: | |||||||||
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| Credential: | MA, NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8801 LIPAN ST | ||||||||
| Address2: | |||||||||
| City: | THORNTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802604912 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1693 QUENTIN ST | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800452518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7208483000 | ||||||||
| FaxNumber: | 7208483015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2017 | ||||||||
| LastUpdateDate: | 03/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | LPCC.0015598 | CO | N | Behavioral Health & Social Service Providers | Counselor | 103TC1900X | 103TC1900X | CO | N | Behavioral Health & Social Service Providers | Psychologist | Counseling | 101YP2500X | LPC.0015741 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.