Provider Demographics
NPI:1801353123
Name:AVITABLE, NANCI (PHD)
Entity type:Individual
Prefix:
First Name:NANCI
Middle Name:
Last Name:AVITABLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2833 S WABASH CIR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4224
Mailing Address - Country:US
Mailing Address - Phone:720-353-1004
Mailing Address - Fax:303-751-1764
Practice Address - Street 1:7535 E HAMPDEN AVE STE 400
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4844
Practice Address - Country:US
Practice Address - Phone:720-353-1004
Practice Address - Fax:303-751-1764
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-22
Last Update Date:2019-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC0008680103T00000X
CO239178103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103T00000XBehavioral Health & Social Service ProvidersPsychologist