Provider Demographics
NPI:1528342706
Name:PATZ, DEBORAH (PSYD, LAC, E-RYT)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:PATZ
Suffix:
Gender:F
Credentials:PSYD, LAC, E-RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5458 MAJESTIC DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-3502
Mailing Address - Country:US
Mailing Address - Phone:719-351-2229
Mailing Address - Fax:
Practice Address - Street 1:5458 MAJESTIC DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-3502
Practice Address - Country:US
Practice Address - Phone:719-351-2229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3616103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COACD1528OtherLICENSED ADDICTION COUNSELOR
CO3616OtherPSYCHOLOGIST LICENSE NUMBER