Provider Demographics
NPI:1285102822
Name:WIENECKE, TIMOTHY ALLEN (LPC, LAC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ALLEN
Last Name:WIENECKE
Suffix:
Gender:M
Credentials:LPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 WASHINGTON AVE APT D
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-5815
Mailing Address - Country:US
Mailing Address - Phone:720-443-1278
Mailing Address - Fax:
Practice Address - Street 1:800 WASHINGTON AVE APT D
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-5815
Practice Address - Country:US
Practice Address - Phone:720-443-1278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0014951101YM0800X
COACD.0001045101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)