Provider Demographics
NPI:1073729828
Name:DATEMA, RALPH S (D MIN)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:S
Last Name:DATEMA
Suffix:
Gender:M
Credentials:D MIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 WARD RD UNIT 212
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-3822
Mailing Address - Country:US
Mailing Address - Phone:303-974-0947
Mailing Address - Fax:720-242-6991
Practice Address - Street 1:1564 SENTER AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80807-1645
Practice Address - Country:US
Practice Address - Phone:303-974-0947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101YP1600X
CO105106H00000X
NE1441 76106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral