Provider Demographics
NPI:1427476720
Name:ULIBARRI, LAWRENCE TED
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:TED
Last Name:ULIBARRI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:LAWRENCE
Other - Middle Name:
Other - Last Name:ULIBARRI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CAC II
Mailing Address - Street 1:1795 JET WING DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80916-2332
Mailing Address - Country:US
Mailing Address - Phone:719-572-6100
Mailing Address - Fax:
Practice Address - Street 1:1795 JET WING DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80916-2332
Practice Address - Country:US
Practice Address - Phone:719-572-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0017632101YP2500X
COABC0007622101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)