Active NPI
Evan Siegel
- Behavior Technician
- Boulder, CO
National Provider Identifier
1487430054
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 23-274424
- Practice address
- 3000 Center Green Dr Ste 120
Boulder, CO 80301-2364 - Phone
- (720) 673-9136
- NPI assigned
- Sep 7, 2023
- Last updated
- Sep 7, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 23-274424 | CO | Primary |
Addresses
Primary practice location
3000 Center Green Dr Ste 120
Boulder, CO 80301-2364
Mailing address
2810 Marine St Apt a
Boulder, CO 80303-5205
Phone (949) 903-3767
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23-274424 | CO | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1694044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694044800000",
"number": "1487430054",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2810 MARINE ST APT A",
"city": "BOULDER",
"state": "CO",
"postal_code": "803035205",
"telephone_number": "949-903-3767"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3000 CENTER GREEN DR STE 120",
"city": "BOULDER",
"state": "CO",
"postal_code": "803012364",
"telephone_number": "720-673-9136"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIEGEL",
"first_name": "EVAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-09-07",
"last_updated": "2023-09-07",
"certification_date": "2023-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CO",
"license": "23-274424",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boulder, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.