Provider Demographics
NPI:1386955680
Name:PETERSON, ELIZABETH KAY (PSYD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KAY
Last Name:PETERSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 E ILIFF AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-3462
Mailing Address - Country:US
Mailing Address - Phone:303-636-5600
Mailing Address - Fax:303-636-5620
Practice Address - Street 1:10375 E HARVARD AVE
Practice Address - Street 2:SUITE 425
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-5939
Practice Address - Country:US
Practice Address - Phone:303-636-5600
Practice Address - Fax:303-636-5620
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3420103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical