Provider Demographics
NPI:1104447093
Name:STARBYRD, DANA TSYCONYEA (LMHC, ATR-P, LMT, HT)
Entity type:Individual
Prefix:MS
First Name:DANA
Middle Name:TSYCONYEA
Last Name:STARBYRD
Suffix:
Gender:F
Credentials:LMHC, ATR-P, LMT, HT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10900 VERMILLION RD
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-9715
Mailing Address - Country:US
Mailing Address - Phone:928-202-8173
Mailing Address - Fax:
Practice Address - Street 1:10900 VERMILLION RD
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-9715
Practice Address - Country:US
Practice Address - Phone:928-202-8173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-01
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCHM02007471101YM0800X
CO101YP1600X
NMMT7360225700000X
COMT.0024579225700000X
NM19-340221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist