Provider Demographics
NPI:1508138322
Name:MANUKYAN, ASMIK (MS)
Entity Type:Individual
Prefix:
First Name:ASMIK
Middle Name:
Last Name:MANUKYAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6093 S QUEBEC ST STE 102
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4543
Mailing Address - Country:US
Mailing Address - Phone:720-947-9485
Mailing Address - Fax:
Practice Address - Street 1:6061 S DETROIT ST
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80121-2809
Practice Address - Country:US
Practice Address - Phone:720-947-9485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12775101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health