Provider Demographics
NPI:1538453774
Name:KOLU, TERESA CAMILLE (BCBA-D)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:CAMILLE
Last Name:KOLU
Suffix:
Gender:F
Credentials:BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10350 DOVER ST
Mailing Address - Street 2:APARTMENT G28
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3937
Mailing Address - Country:US
Mailing Address - Phone:303-507-6100
Mailing Address - Fax:
Practice Address - Street 1:1400 DIXON AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2790
Practice Address - Country:US
Practice Address - Phone:303-507-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-11-8178103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst