Provider Demographics
NPI:1093194078
Name:NEITZEL, ANDRE
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:NEITZEL
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 1:3520 W 92ND AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-3304
Mailing Address - Country:US
Mailing Address - Phone:720-505-6843
Mailing Address - Fax:
Practice Address - Street 1:3520 W 92ND AVE
Practice Address - Street 2:STE 104
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-3304
Practice Address - Country:US
Practice Address - Phone:720-505-6843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-24
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00099200961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical