Provider Demographics
NPI:1205250008
Name:ENTMACHER, DAN
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:ENTMACHER
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 1:1503 SPRUCE ST
Mailing Address - Street 2:6
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-4209
Mailing Address - Country:US
Mailing Address - Phone:720-441-2998
Mailing Address - Fax:
Practice Address - Street 1:1503 SPRUCE ST # 6
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-4209
Practice Address - Country:US
Practice Address - Phone:720-441-2998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health