Provider Demographics
NPI:1972123131
Name:SERNA, SIERRA KIMBERLY
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:KIMBERLY
Last Name:SERNA
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 1:13122 CLAYTON CT
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-2053
Mailing Address - Country:US
Mailing Address - Phone:303-968-7905
Mailing Address - Fax:
Practice Address - Street 1:13122 CLAYTON CT
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-2053
Practice Address - Country:US
Practice Address - Phone:303-968-7905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO10161997Medicaid