Provider Demographics
NPI:1477306769
Name:VETTIYAZHEECKAL PATHROSE, SALES (LPCC)
Entity Type:Individual
Prefix:MR
First Name:SALES
Middle Name:
Last Name:VETTIYAZHEECKAL PATHROSE
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5990 GREENWOOD PLAZA BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4712
Mailing Address - Country:US
Mailing Address - Phone:830-388-6035
Mailing Address - Fax:
Practice Address - Street 1:750 W HAMPDEN AVE STE 415
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2151
Practice Address - Country:US
Practice Address - Phone:830-388-6035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19438101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional