Provider Demographics
NPI:1518481746
Name:GIUSTI, IGOR (MA, ABD, CAC I)
Entity Type:Individual
Prefix:MR
First Name:IGOR
Middle Name:
Last Name:GIUSTI
Suffix:
Gender:M
Credentials:MA, ABD, CAC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 MANHATTAN DR STE 302
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-4253
Mailing Address - Country:US
Mailing Address - Phone:443-254-8935
Mailing Address - Fax:
Practice Address - Street 1:75 MANHATTAN DR STE 302
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-4253
Practice Address - Country:US
Practice Address - Phone:443-254-8935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-30
Last Update Date:2017-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13722101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty