Provider Demographics
NPI:1831279975
Name:DEMANDER, SAM NEIL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:NEIL
Last Name:DEMANDER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19731 E. PIKES PEAK CT,
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-7803
Mailing Address - Country:US
Mailing Address - Phone:303-841-6561
Mailing Address - Fax:303-841-6571
Practice Address - Street 1:19731 E. PIKES PEAK CT,
Practice Address - Street 2:SUITE 101
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-7803
Practice Address - Country:US
Practice Address - Phone:303-841-6561
Practice Address - Fax:303-841-6571
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO901103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO20-1089973OtherEIN