Provider Demographics
NPI:1326453341
Name:BIRMINGHAM, RHAE (MA, LPC, LAC)
Entity Type:Individual
Prefix:
First Name:RHAE
Middle Name:
Last Name:BIRMINGHAM
Suffix:
Gender:F
Credentials:MA, LPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 LILAC CT
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1009
Mailing Address - Country:US
Mailing Address - Phone:720-409-6881
Mailing Address - Fax:
Practice Address - Street 1:1634 WALNUT ST STE 221
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5400
Practice Address - Country:US
Practice Address - Phone:720-409-6881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-27
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001280101YA0400X
COLPC.0016166101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)