Provider Demographics
NPI:1861263865
Name:ADMASU, BEZAWIT YITAYEW
Entity type:Individual
Prefix:
First Name:BEZAWIT
Middle Name:YITAYEW
Last Name:ADMASU
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:PO BOX 44364
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80201-4364
Mailing Address - Country:US
Mailing Address - Phone:720-394-0632
Mailing Address - Fax:
Practice Address - Street 1:8415 EXPLORER DR STE 130
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1034
Practice Address - Country:US
Practice Address - Phone:720-394-0632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CON.A103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy