Provider Demographics
NPI:1003969379
Name:HUEFTLE, RONALD KEENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:KEENE
Last Name:HUEFTLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 UNION BLVD
Mailing Address - Street 2:STE 221
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401
Mailing Address - Country:US
Mailing Address - Phone:303-271-1213
Mailing Address - Fax:303-987-3455
Practice Address - Street 1:445 UNION BLVD
Practice Address - Street 2:STE 221
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80401
Practice Address - Country:US
Practice Address - Phone:303-271-1213
Practice Address - Fax:303-987-3455
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1896103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
88296Medicare ID - Type Unspecified