Provider Demographics
NPI:1518451855
Name:SIERRA PEAKS BEHAVIORAL SOLUTIONS, LLC
Entity Type:Organization
Organization Name:SIERRA PEAKS BEHAVIORAL SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/BEHAVIOR THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIZENZO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:505-860-9592
Mailing Address - Street 1:361 S CAMINO DEL RIO # 238
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-7997
Mailing Address - Country:US
Mailing Address - Phone:505-860-9592
Mailing Address - Fax:970-382-9301
Practice Address - Street 1:361 S CAMINO DEL RIO # 238
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-7997
Practice Address - Country:US
Practice Address - Phone:505-860-9592
Practice Address - Fax:970-382-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1-07467251S00000X
CO1769251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health