Provider Demographics
NPI:1053442731
Name:MAESTAS, DONALD RAYMOND JR (LPC, LAC)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:RAYMOND
Last Name:MAESTAS
Suffix:JR
Gender:M
Credentials:LPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4163 QUITMAN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-2127
Mailing Address - Country:US
Mailing Address - Phone:303-550-8382
Mailing Address - Fax:
Practice Address - Street 1:4163 QUITMAN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-2127
Practice Address - Country:US
Practice Address - Phone:303-550-8382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO211101YA0400X
COLPC-6499101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)