Individual Provider

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

NLC.0105326 Issued in CO

Legal business name

INDIVIDUAL PROVIDER

Practice address

4159 Lowell Blvd
Denver, CO 80211-1658

Phone

(303) 458-7220

NPI assigned

Jun 11, 2015

Last updated

Jun 11, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Alicia D Leto, M.A.

Title

Therapist

Phone

(970) 618-6796

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1433980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433980800000",
    "number": "1821479122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 KALMIA AVE",
            "address_2": "#A204",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803011542",
            "telephone_number": "970-618-6796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4159 LOWELL BLVD",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802111658",
            "telephone_number": "303-458-7220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIVIDUAL PROVIDER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-11",
        "last_updated": "2015-06-11",
        "status": "A",
        "authorized_official_last_name": "LETO",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "970-618-6796",
        "authorized_official_credential": "M.A."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "CO",
            "license": "NLC.0105326",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.