Provider Demographics
NPI:1508013509
Name:FASULA, ANDREA T (BS)
Entity Type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:T
Last Name:FASULA
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15590 INDIANA GULCH
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80455-9722
Mailing Address - Country:US
Mailing Address - Phone:303-459-0216
Mailing Address - Fax:
Practice Address - Street 1:1333 IRIS AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-2226
Practice Address - Country:US
Practice Address - Phone:303-443-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor