Provider Demographics
NPI:1922310390
Name:ALTIZER, CHRISTINE O
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:O
Last Name:ALTIZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2613 FERNWOOD PL
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-5488
Mailing Address - Country:US
Mailing Address - Phone:303-503-0364
Mailing Address - Fax:
Practice Address - Street 1:2613 FERNWOOD PL
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-5488
Practice Address - Country:US
Practice Address - Phone:303-503-0364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-10-7180103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst