Provider Demographics
NPI:1407070097
Name:SALAS, CONSUELO DE JESUS (BA)
Entity Type:Individual
Prefix:
First Name:CONSUELO
Middle Name:DE JESUS
Last Name:SALAS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6509 S SANTA FE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-2910
Mailing Address - Country:US
Mailing Address - Phone:303-730-8858
Mailing Address - Fax:
Practice Address - Street 1:6509 S SANTA FE DR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-2910
Practice Address - Country:US
Practice Address - Phone:303-730-8858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO320800000X320800000X
COCSW.099273521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness