Provider Demographics
NPI:1740383660
Name:WINSTON, MICHELLE C (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:C
Last Name:WINSTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6375 EAGLE CT
Mailing Address - Street 2:
Mailing Address - City:NIWOT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-8331
Mailing Address - Country:US
Mailing Address - Phone:303-444-1655
Mailing Address - Fax:866-761-2164
Practice Address - Street 1:6375 EAGLE CT
Practice Address - Street 2:
Practice Address - City:NIWOT
Practice Address - State:CO
Practice Address - Zip Code:80503-8331
Practice Address - Country:US
Practice Address - Phone:303-444-1655
Practice Address - Fax:866-761-2164
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1314103TC0700X, 103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC99086Medicare UPIN
COC99086Medicare UPIN