Provider Demographics
NPI:1699969899
Name:DIRZUWEIT, STACEY CAROL (MA, LMFT, ATR)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:CAROL
Last Name:DIRZUWEIT
Suffix:
Gender:F
Credentials:MA, LMFT, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12157 W CEDAR DR STE 203
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-2100
Mailing Address - Country:US
Mailing Address - Phone:720-526-3132
Mailing Address - Fax:303-985-7882
Practice Address - Street 1:12157 W CEDAR DR STE 203
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-2100
Practice Address - Country:US
Practice Address - Phone:720-526-3132
Practice Address - Fax:303-985-7882
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA09-027221700000X
COLMFT.0001397106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1699969899Medicaid