Basic Information
| Provider Information | |||||||||
| NPI: | 1417317983 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIETTE | ||||||||
| FirstName: | MOLLY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 141 S JOLIET CIR APT 14-306 | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800126405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5082218833 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1330 QUAIL LAKE LOOP SUITE 120 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7199244533 | ||||||||
| FaxNumber: | 7195760089 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2016 | ||||||||
| LastUpdateDate: | 12/08/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-16-24218 | CO | Y | Behavioral Health & Social Service Providers | Behavioral Analyst | 106E00000X | 0-15-6854 | CO | N |
No ID Information.