Provider Demographics
NPI:1396118857
Name:WESSEL, THEA (LPC, LAC, MAC, NCAAC)
Entity type:Individual
Prefix:
First Name:THEA
Middle Name:
Last Name:WESSEL
Suffix:
Gender:F
Credentials:LPC, LAC, MAC, NCAAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 592
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80038-0592
Mailing Address - Country:US
Mailing Address - Phone:781-990-8432
Mailing Address - Fax:
Practice Address - Street 1:1333 W 120TH AVE STE 222
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-2710
Practice Address - Country:US
Practice Address - Phone:781-990-8432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0000294101YA0400X
VAMAC 507660101YA0400X
COLPC.0011167101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional