Provider Demographics
NPI:1437265725
Name:BAKSHT, LEONID (AUP)
Entity Type:Individual
Prefix:
First Name:LEONID
Middle Name:
Last Name:BAKSHT
Suffix:
Gender:M
Credentials:AUP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 S TAMARAC DR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4394
Mailing Address - Country:US
Mailing Address - Phone:303-597-7777
Mailing Address - Fax:303-597-7700
Practice Address - Street 1:3201 S TAMARAC DR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4394
Practice Address - Country:US
Practice Address - Phone:303-597-7777
Practice Address - Fax:303-597-7700
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8559103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO947539Medicaid
CO9`47539Medicaid