Provider Demographics
NPI:1528633351
Name:DOUZIECH, LUBA MARIA
Entity type:Individual
Prefix:
First Name:LUBA
Middle Name:MARIA
Last Name:DOUZIECH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34507 SQUAW PASS RD
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-9727
Mailing Address - Country:US
Mailing Address - Phone:720-642-6880
Mailing Address - Fax:
Practice Address - Street 1:34507 SQUAW PASS RD
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-9727
Practice Address - Country:US
Practice Address - Phone:720-642-6880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2023-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12032004-3502101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty