Provider Demographics
NPI:1619179025
Name:COSTAS, WILLIAM N (PSYD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:N
Last Name:COSTAS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7996 S VINCENNES WAY
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3333
Mailing Address - Country:US
Mailing Address - Phone:303-919-0000
Mailing Address - Fax:
Practice Address - Street 1:7996 S VINCENNES WAY
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3333
Practice Address - Country:US
Practice Address - Phone:303-919-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1301103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07000292Medicaid
COC81596Medicare ID - Type UnspecifiedMEDICARE
CO07000292Medicaid