Provider Demographics
NPI:1154125805
Name:ALIREZ, LEO (PHD, CAS)
Entity type:Individual
Prefix:
First Name:LEO
Middle Name:
Last Name:ALIREZ
Suffix:
Gender:
Credentials:PHD, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 W BAYAUD AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80223-1213
Mailing Address - Country:US
Mailing Address - Phone:720-275-1739
Mailing Address - Fax:
Practice Address - Street 1:1240 W BAYAUD AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80223-1213
Practice Address - Country:US
Practice Address - Phone:720-275-1739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC.0006677101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)