Provider Demographics
NPI:1063028637
Name:FRIEDENTAG, DAVID BRYAN (LPC 3994, LAC 123)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BRYAN
Last Name:FRIEDENTAG
Suffix:
Gender:M
Credentials:LPC 3994, LAC 123
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3855 S MONACO PKWY APT 101
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-1207
Mailing Address - Country:US
Mailing Address - Phone:303-915-4748
Mailing Address - Fax:
Practice Address - Street 1:3855 S MONACO PKWY APT 101
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-1207
Practice Address - Country:US
Practice Address - Phone:303-915-4748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-19
Last Update Date:2020-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3994101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health