Provider Demographics
NPI:1083445134
Name:DUSHMAN, RAPHAEL J (BA, MA, MFTC)
Entity type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:J
Last Name:DUSHMAN
Suffix:
Gender:M
Credentials:BA, MA, MFTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13670 VIA VARRA APT 327
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-9738
Mailing Address - Country:US
Mailing Address - Phone:847-721-9556
Mailing Address - Fax:
Practice Address - Street 1:3000 S COLLEGE AVE UNIT 210
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2558
Practice Address - Country:US
Practice Address - Phone:970-472-1207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFTC.0014687106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist