Provider Demographics
NPI:1922577345
Name:NORRIS, ANTUAN
Entity Type:Individual
Prefix:
First Name:ANTUAN
Middle Name:
Last Name:NORRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1092 COPPER MOUNTAIN LN
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-2360
Mailing Address - Country:US
Mailing Address - Phone:843-901-7868
Mailing Address - Fax:
Practice Address - Street 1:1613 PROSPECT PKWY STE 110
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-9707
Practice Address - Country:US
Practice Address - Phone:970-377-9401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician