Provider Demographics
NPI:1245923697
Name:SPYKSTRA, ELISA LANAE
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:LANAE
Last Name:SPYKSTRA
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 1:8500 E JEFFERSON AVE APT 18B
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-1594
Mailing Address - Country:US
Mailing Address - Phone:303-915-1247
Mailing Address - Fax:
Practice Address - Street 1:5931 MIDDLEFIELD RD STE 103
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-2865
Practice Address - Country:US
Practice Address - Phone:303-915-1247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0018240101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health