Provider Demographics
NPI:1558412312
Name:COSTER, ANTHEA G (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANTHEA
Middle Name:G
Last Name:COSTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30186 BOYNE CT
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-9420
Mailing Address - Country:US
Mailing Address - Phone:303-919-8842
Mailing Address - Fax:
Practice Address - Street 1:30186 BOYNE CT
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-9420
Practice Address - Country:US
Practice Address - Phone:303-919-8842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2014-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3012101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional