Provider Demographics
NPI:1649586405
Name:MICHENER, JUSTIN (PHD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:MICHENER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3351 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-3138
Mailing Address - Country:US
Mailing Address - Phone:914-260-8151
Mailing Address - Fax:
Practice Address - Street 1:7180 E ORCHARD RD STE 201
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-1724
Practice Address - Country:US
Practice Address - Phone:914-260-8151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4504103T00000X
MS51-891103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical