Provider Demographics
NPI:1891223251
Name:PALOMBO, IAN JOSEPH (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:IAN
Middle Name:JOSEPH
Last Name:PALOMBO
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 S ONEIDA ST STE 600
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-2555
Mailing Address - Country:US
Mailing Address - Phone:720-863-6112
Mailing Address - Fax:720-554-7739
Practice Address - Street 1:2121 S ONEIDA ST STE 600
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224
Practice Address - Country:US
Practice Address - Phone:720-863-6100
Practice Address - Fax:720-554-7739
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013763101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO900014794Medicaid