Provider Demographics
NPI:1376992149
Name:FOLKERTS, CONNOR
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:
Last Name:FOLKERTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 N LINCOLN ST
Mailing Address - Street 2:3I NORTH
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-2725
Mailing Address - Country:US
Mailing Address - Phone:303-324-5742
Mailing Address - Fax:
Practice Address - Street 1:975 N LINCOLN ST
Practice Address - Street 2:3I NORTH
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-2725
Practice Address - Country:US
Practice Address - Phone:303-324-5742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-12
Last Update Date:2016-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness