Provider Demographics
NPI:1346586294
Name:SERENE PSYCHOTHERAPY
Entity Type:Organization
Organization Name:SERENE PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:NASRIN
Authorized Official - Last Name:YAZDI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:720-346-8557
Mailing Address - Street 1:1776 S JACKSON ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3801
Mailing Address - Country:US
Mailing Address - Phone:720-346-8557
Mailing Address - Fax:972-736-2271
Practice Address - Street 1:1776 S JACKSON ST
Practice Address - Street 2:SUITE 207
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3801
Practice Address - Country:US
Practice Address - Phone:720-346-8557
Practice Address - Fax:972-736-2271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-21
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11175101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty