Provider Demographics
NPI:1518274075
Name:DENTRY, JUSTIN BLUE (MS, LPC)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:BLUE
Last Name:DENTRY
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7862 W MANSFIELD PKWY
Mailing Address - Street 2:BUILDING
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80235-1934
Mailing Address - Country:US
Mailing Address - Phone:720-879-8910
Mailing Address - Fax:
Practice Address - Street 1:7862 W MANSFIELD PKWY
Practice Address - Street 2:BUILDING
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80235-1934
Practice Address - Country:US
Practice Address - Phone:720-879-8910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-04
Last Update Date:2010-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5783101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health