Provider Demographics
NPI:1295430502
Name:MORAN, RESA
Entity type:Individual
Prefix:
First Name:RESA
Middle Name:
Last Name:MORAN
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 1:25463 VAIL RD
Mailing Address - Street 2:
Mailing Address - City:CEDAREDGE
Mailing Address - State:CO
Mailing Address - Zip Code:81413-8168
Mailing Address - Country:US
Mailing Address - Phone:303-453-9893
Mailing Address - Fax:
Practice Address - Street 1:25463 VAIL RD
Practice Address - Street 2:
Practice Address - City:CEDAREDGE
Practice Address - State:CO
Practice Address - Zip Code:81413-8168
Practice Address - Country:US
Practice Address - Phone:303-453-9893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-04
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health