Provider Demographics
NPI:1336432020
Name:LATINO PSYCHOTHERAPY & DEVELOPMENT SERVICES
Entity Type:Organization
Organization Name:LATINO PSYCHOTHERAPY & DEVELOPMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELISELDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSTILLOS
Authorized Official - Suffix:
Authorized Official - Credentials:BA, CAC III
Authorized Official - Phone:720-810-4063
Mailing Address - Street 1:12101 E. SECOND AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12101 E. SECOND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011
Practice Address - Country:US
Practice Address - Phone:720-810-4063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health