Provider Demographics
NPI:1316703523
Name:TREGER, ELISABETH ANNE
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:ANNE
Last Name:TREGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 PALO PKWY
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3699
Mailing Address - Country:US
Mailing Address - Phone:312-404-2482
Mailing Address - Fax:
Practice Address - Street 1:3434 47TH ST STE 130
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1802
Practice Address - Country:US
Practice Address - Phone:312-404-2482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0021784101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health