Provider Demographics
NPI:1588140222
Name:HARTZENBERG, THEODORE HUGHAR
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:HUGHAR
Last Name:HARTZENBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MEANINGFUL
Other - Middle Name:LIFE
Other - Last Name:COUNSELING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2101 S BLACKHAWK ST STE 240
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1475
Mailing Address - Country:US
Mailing Address - Phone:970-587-3764
Mailing Address - Fax:
Practice Address - Street 1:2101 S BLACKHAWK ST STE 240
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1475
Practice Address - Country:US
Practice Address - Phone:970-587-3764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0017225101YP2500X
COACD.0001465101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty