Provider Demographics
NPI:1669087334
Name:CORDREY, ASTRA (CAS)
Entity type:Individual
Prefix:
First Name:ASTRA
Middle Name:
Last Name:CORDREY
Suffix:
Gender:F
Credentials:CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 PEREGRINE LN
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:CO
Mailing Address - Zip Code:80540-4211
Mailing Address - Country:US
Mailing Address - Phone:860-751-4789
Mailing Address - Fax:
Practice Address - Street 1:2114 MIDPOINT DR UNIT 4
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4324
Practice Address - Country:US
Practice Address - Phone:970-372-3144
Practice Address - Fax:970-482-1921
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC.0998669101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)