Provider Demographics
NPI:1407168149
Name:BERZINS, GISELE SHEA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:GISELE
Middle Name:SHEA
Last Name:BERZINS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:548 MOUNTAIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:BERTHOUD
Mailing Address - State:CO
Mailing Address - Zip Code:80513
Mailing Address - Country:US
Mailing Address - Phone:303-408-0366
Mailing Address - Fax:
Practice Address - Street 1:548 MOUNTAIN AVENUE
Practice Address - Street 2:
Practice Address - City:BERTHOUD
Practice Address - State:CO
Practice Address - Zip Code:80513
Practice Address - Country:US
Practice Address - Phone:303-408-0366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-10
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6204101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health