Provider Demographics
NPI:1962486068
Name:TEMPLETON, MICHELLE MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MARIE
Last Name:TEMPLETON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1224
Mailing Address - Street 2:
Mailing Address - City:EASTLAKE
Mailing Address - State:CO
Mailing Address - Zip Code:80614-1224
Mailing Address - Country:US
Mailing Address - Phone:720-425-1111
Mailing Address - Fax:303-648-4114
Practice Address - Street 1:12021 PENNSYLVANIA ST STE 202
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-3152
Practice Address - Country:US
Practice Address - Phone:720-425-1111
Practice Address - Fax:303-450-1574
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2934103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN847102900Medicaid
MN764M4TEOtherBCBS