Provider Demographics
NPI:1235108994
Name:SIITERI, ERIC H (PHD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:H
Last Name:SIITERI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 955
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80522-0955
Mailing Address - Country:US
Mailing Address - Phone:970-495-0707
Mailing Address - Fax:970-495-6885
Practice Address - Street 1:111 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2665
Practice Address - Country:US
Practice Address - Phone:970-495-0707
Practice Address - Fax:970-495-6885
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1816103TC0700X
WY278103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY118233101Medicaid
WYW9300Medicare ID - Type Unspecified
WYW9300Medicare ID - Type Unspecified