Provider Demographics
NPI:1336387380
Name:SCHMIDT, THERESA M (CAC III)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2557 S DOVER ST
Mailing Address - Street 2:UNIT-69
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-3149
Mailing Address - Country:US
Mailing Address - Phone:303-436-5706
Mailing Address - Fax:303-436-5071
Practice Address - Street 1:2557 S DOVER ST
Practice Address - Street 2:UNIT-69
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-3149
Practice Address - Country:US
Practice Address - Phone:303-436-5706
Practice Address - Fax:303-436-5071
Is Sole Proprietor?:No
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3077101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO841343242Medicaid