Basic Information
| Provider Information | |||||||||
| NPI: | 1639200322 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THEEL | ||||||||
| FirstName: | KARA | ||||||||
| MiddleName: | KRISTINE | ||||||||
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| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TABOR | ||||||||
| OtherFirstName: | KARA | ||||||||
| OtherMiddleName: | KRISTINE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4394 S JOPLIN WAY | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800154427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033719696 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1733 VINE ST | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802061119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035041000 | ||||||||
| FaxNumber: | 3033949820 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.