Provider Demographics
NPI:1083955975
Name:FIRE, MICHAL
Entity Type:Individual
Prefix:
First Name:MICHAL
Middle Name:
Last Name:FIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7497A N FOOTHILLS HWY
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-9359
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1033 KALMIA AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-1743
Practice Address - Country:US
Practice Address - Phone:415-508-7042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-03
Last Update Date:2013-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3735103TC0700X
CA24766103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical