Provider Demographics
NPI:1639389950
Name:FOOTE, HANS WALTHER FREYBERG (PSYD)
Entity Type:Individual
Prefix:DR
First Name:HANS
Middle Name:WALTHER FREYBERG
Last Name:FOOTE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:HANS
Other - Middle Name:WALTHER
Other - Last Name:FREYBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:660 S 41ST ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-5915
Mailing Address - Country:US
Mailing Address - Phone:720-937-6443
Mailing Address - Fax:
Practice Address - Street 1:531 ARAPAHOE AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5826
Practice Address - Country:US
Practice Address - Phone:720-937-6443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2008-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3056103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical