Provider Demographics
NPI:1326850264
Name:MENARD, DEMITRA (MFTC)
Entity type:Individual
Prefix:
First Name:DEMITRA
Middle Name:
Last Name:MENARD
Suffix:
Gender:F
Credentials:MFTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17130 PROFFITS PT
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-7138
Mailing Address - Country:US
Mailing Address - Phone:805-242-3447
Mailing Address - Fax:
Practice Address - Street 1:1777 S BELLAIRE ST STE 165
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4310
Practice Address - Country:US
Practice Address - Phone:303-217-2658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFTC.0014495106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist