Provider Demographics
NPI:1992211734
Name:RUBIN, WILLOW (MA LPC LMFT)
Entity Type:Individual
Prefix:
First Name:WILLOW
Middle Name:
Last Name:RUBIN
Suffix:
Gender:F
Credentials:MA LPC LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4631 W MONCRIEFF PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-1603
Mailing Address - Country:US
Mailing Address - Phone:310-388-7741
Mailing Address - Fax:
Practice Address - Street 1:600 S CHERRY ST STE 217
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CO
Practice Address - Zip Code:80246-1704
Practice Address - Country:US
Practice Address - Phone:310-388-7741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4135101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health