Basic Information
| Provider Information | |||||||||
| NPI: | 1588982029 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STRUCTURED LEARNING ASPECTS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 MARKET ST APT 328 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802052097 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7204700578 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2101 MARKET ST APT 328 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802052097 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7204700578 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2010 | ||||||||
| LastUpdateDate: | 05/07/2010 | ||||||||
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| AuthorizedOfficialLastName: | BURTCH | ||||||||
| AuthorizedOfficialFirstName: | KEELEE | ||||||||
| AuthorizedOfficialMiddleName: | KATHLEEN | ||||||||
| AuthorizedOfficialTitleorPosition: | CLINICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7204700578 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 0389660 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
ID Information
| ID | Type | State | Issuer | Description | 19100078 | 05 | CO | MEDICAID | 77634772 | 05 | CO | MEDICAID |