Provider Demographics
NPI:1972001568
Name:QUEER ASTERISK
Entity Type:Organization
Organization Name:QUEER ASTERISK
Other - Org Name:THERAPEUTIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SORIN
Authorized Official - Middle Name:LORNE
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-253-2187
Mailing Address - Street 1:1575 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1624
Mailing Address - Country:US
Mailing Address - Phone:303-253-2187
Mailing Address - Fax:
Practice Address - Street 1:1575 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1624
Practice Address - Country:US
Practice Address - Phone:303-253-2187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-29
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000159362Medicaid