Basic Information
Provider Information | |||||||||
NPI: | 1700024478 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | TOYS | ||||||||
FirstName: | SUSAN | ||||||||
MiddleName: | M. | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | LISTEBARGER | ||||||||
OtherFirstName: | SUSAN | ||||||||
OtherMiddleName: | M. | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 40 | ||||||||
Address2: |   | ||||||||
City: | GLENWOOD SPRINGS | ||||||||
State: | CO | ||||||||
PostalCode: | 816020040 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9709452241 | ||||||||
FaxNumber: | 9709455523 | ||||||||
Practice Location | |||||||||
Address1: | 360 PEAK ONE DRIVE | ||||||||
Address2: | SUITE 110 | ||||||||
City: | FRISCO | ||||||||
State: | CO | ||||||||
PostalCode: | 80443 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9706683478 | ||||||||
FaxNumber: | 9706680632 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/03/2009 | ||||||||
LastUpdateDate: | 02/03/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 2905 | CO | Y |   | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.