Provider Demographics
NPI:1548774839
Name:DIETERICH, MAUREEN ANNE (LPC)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:ANNE
Last Name:DIETERICH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1944 CHESAPEAKE LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-4040
Mailing Address - Country:US
Mailing Address - Phone:720-708-9397
Mailing Address - Fax:
Practice Address - Street 1:1850 RACE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1116
Practice Address - Country:US
Practice Address - Phone:303-502-5880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-22
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0013963101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional