Provider Demographics
NPI:1215522669
Name:BEAN, VANESSA (PHD)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:BEAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 28TH ST STE 200B
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1756
Mailing Address - Country:US
Mailing Address - Phone:720-924-9873
Mailing Address - Fax:
Practice Address - Street 1:1200 28TH ST STE 200B
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1756
Practice Address - Country:US
Practice Address - Phone:720-924-9873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.00005087103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty