Provider Demographics
NPI:1083355150
Name:WESTGAARD, PAUL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:WESTGAARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1369 FOREST PARK CIR STE 204
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-3485
Mailing Address - Country:US
Mailing Address - Phone:720-708-2972
Mailing Address - Fax:
Practice Address - Street 1:1369 FOREST PARK CIR STE 204
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3485
Practice Address - Country:US
Practice Address - Phone:720-708-2972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0019139101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
COLLPC.0019139OtherLICENSURE