Provider Demographics
NPI:1407333834
Name:MAESTAS, SUWATTANA CHUMPOLKULWONG (LPC)
Entity Type:Individual
Prefix:MS
First Name:SUWATTANA
Middle Name:CHUMPOLKULWONG
Last Name:MAESTAS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:SUWATTANA
Other - Middle Name:
Other - Last Name:CHUMPOLKULWONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4163 QUITMAN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-2127
Mailing Address - Country:US
Mailing Address - Phone:720-446-6175
Mailing Address - Fax:
Practice Address - Street 1:1290 CHAMBERS RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-7117
Practice Address - Country:US
Practice Address - Phone:303-617-2300
Practice Address - Fax:303-617-2344
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0014789101YM0800X
COLPC.0016443101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health