Provider Demographics
NPI:1194252312
Name:WINANS, ANDREW TAYLOR (RBT-17-33515)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:TAYLOR
Last Name:WINANS
Suffix:
Gender:M
Credentials:RBT-17-33515
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2873 CROOKED WASH DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-7272
Mailing Address - Country:US
Mailing Address - Phone:720-325-8680
Mailing Address - Fax:
Practice Address - Street 1:6767 S SPRUCE ST STE 100
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-6118
Practice Address - Country:US
Practice Address - Phone:303-225-7673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-17-33515106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CORBT-17-33515OtherBACB