Provider Demographics
NPI:1619389640
Name:FRITZEN, CARL
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:FRITZEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15037 E LOUISIANA DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-7752
Mailing Address - Country:US
Mailing Address - Phone:719-248-8880
Mailing Address - Fax:
Practice Address - Street 1:50 S STEELE ST STE 950
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-2843
Practice Address - Country:US
Practice Address - Phone:719-248-8880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-26
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0016075101YP2500X
171M00000X
COLPC.0017861101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator