Provider Demographics
NPI:1356478853
Name:LONGORIA, DENNISHA BERNELL (BA)
Entity Type:Individual
Prefix:
First Name:DENNISHA
Middle Name:BERNELL
Last Name:LONGORIA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:DENNISHA
Other - Middle Name:BERNELL
Other - Last Name:BARNUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1705 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-4015
Mailing Address - Country:US
Mailing Address - Phone:719-336-0828
Mailing Address - Fax:
Practice Address - Street 1:3500 1ST STREET SOUTH
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052
Practice Address - Country:US
Practice Address - Phone:719-336-7501
Practice Address - Fax:719-336-7453
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor