Provider Demographics
NPI:1861775819
Name:KOUIMELIS, FAYE N (PSYD, OTR)
Entity type:Individual
Prefix:DR
First Name:FAYE
Middle Name:N
Last Name:KOUIMELIS
Suffix:
Gender:F
Credentials:PSYD, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6860 S YOSEMITE CT STE 2218
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1409
Mailing Address - Country:US
Mailing Address - Phone:720-500-2062
Mailing Address - Fax:
Practice Address - Street 1:6860 S YOSEMITE CT STE 2218
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1409
Practice Address - Country:US
Practice Address - Phone:720-500-2062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0006301103TC0700X
COOT.0005678225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics