Provider Demographics
NPI:1265922793
Name:WESTBACK, ANGELA (RBT-17-37744)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:WESTBACK
Suffix:
Gender:F
Credentials:RBT-17-37744
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8391 BLACKGUM ST
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-8702
Mailing Address - Country:US
Mailing Address - Phone:303-594-3931
Mailing Address - Fax:
Practice Address - Street 1:8391 BLACKGUM ST
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-8702
Practice Address - Country:US
Practice Address - Phone:303-594-3931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17-37744106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician