Provider Demographics
NPI:1588202147
Name:STRAKA, ELIZABETH TRACEY
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:TRACEY
Last Name:STRAKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 DEERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-8804
Mailing Address - Country:US
Mailing Address - Phone:720-684-8565
Mailing Address - Fax:
Practice Address - Street 1:5400 WARD RD BLDG 2
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-1819
Practice Address - Country:US
Practice Address - Phone:303-667-3098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-18-32332103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst