Basic Information
| Provider Information | |||||||||
| NPI: | 1700517067 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOOR | ||||||||
| FirstName: | ALESSA | ||||||||
| MiddleName: | NOELY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 POTOMAC ST | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800116844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036952600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 700 POTOMAC ST | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800116844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036952600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2022 | ||||||||
| LastUpdateDate: | 06/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
ID Information
| ID | Type | State | Issuer | Description | 236 | 05 | CO | MEDICAID |