Provider Demographics
NPI:1396140067
Name:WOMELDORFF, TRENT (RN PSYD)
Entity type:Individual
Prefix:MR
First Name:TRENT
Middle Name:
Last Name:WOMELDORFF
Suffix:
Gender:M
Credentials:RN PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 S PENNSYLVANIA ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-4749
Mailing Address - Country:US
Mailing Address - Phone:303-912-1247
Mailing Address - Fax:
Practice Address - Street 1:4201 S PENNSYLVANIA ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-4749
Practice Address - Country:US
Practice Address - Phone:303-912-1247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health