Provider Demographics
NPI:1245759901
Name:WECKER, KELLY LEE STITELER
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LEE STITELER
Last Name:WECKER
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 1:9135 RIDGELINE BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2395
Mailing Address - Country:US
Mailing Address - Phone:303-800-6093
Mailing Address - Fax:
Practice Address - Street 1:9135 RIDGELINE BLVD STE 160
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2395
Practice Address - Country:US
Practice Address - Phone:303-800-6093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
COLPC.0017618101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health