Provider Demographics
NPI:1568507952
Name:PONTIFLET, KEITH DE'MEL (CAC III)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:DE'MEL
Last Name:PONTIFLET
Suffix:
Gender:M
Credentials:CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14221 E 1ST DR
Mailing Address - Street 2:#201
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-3811
Mailing Address - Country:US
Mailing Address - Phone:720-327-8821
Mailing Address - Fax:
Practice Address - Street 1:14231 E 4TH AVE STE 370
Practice Address - Street 2:BLUDING 1
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-8720
Practice Address - Country:US
Practice Address - Phone:303-856-3485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC0006578101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health