Provider Demographics
NPI:1902357197
Name:ESP, WILLIAM LEROY (LAC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LEROY
Last Name:ESP
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7908 CHASE CIR
Mailing Address - Street 2:139
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-2547
Mailing Address - Country:US
Mailing Address - Phone:303-525-4619
Mailing Address - Fax:
Practice Address - Street 1:1360 S WADSWORTH BLVD
Practice Address - Street 2:112
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-5415
Practice Address - Country:US
Practice Address - Phone:303-525-4619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-22
Last Update Date:2016-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)