Provider Demographics
NPI:1457866915
Name:MICHAEL DAWSON
Entity Type:Organization
Organization Name:MICHAEL DAWSON
Other - Org Name:MDC GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:303-766-4111
Mailing Address - Street 1:2851 S PARKER RD STE 436
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2802
Mailing Address - Country:US
Mailing Address - Phone:303-766-4111
Mailing Address - Fax:
Practice Address - Street 1:2851 S PARKER RD STE 436
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2802
Practice Address - Country:US
Practice Address - Phone:303-766-4111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO00720071Medicaid