Provider Demographics
NPI:1154068740
Name:SMALL, ROSELYN R (LPCC, LAC)
Entity Type:Individual
Prefix:
First Name:ROSELYN
Middle Name:R
Last Name:SMALL
Suffix:
Gender:F
Credentials:LPCC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2880 W HOLDEN PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-3353
Mailing Address - Country:US
Mailing Address - Phone:303-953-6612
Mailing Address - Fax:
Practice Address - Street 1:2880 W HOLDEN PL
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-3353
Practice Address - Country:US
Practice Address - Phone:303-953-6612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor