Provider Demographics
NPI:1831313188
Name:KNAUB, DEBRA KAYE (MA)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:KAYE
Last Name:KNAUB
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 KIPLING ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-2848
Mailing Address - Country:US
Mailing Address - Phone:303-274-4200
Mailing Address - Fax:303-274-4201
Practice Address - Street 1:1701 KIPLING ST STE 102
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-2848
Practice Address - Country:US
Practice Address - Phone:303-274-4200
Practice Address - Fax:303-274-4201
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
COACD0002030101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO49484729Medicaid