Provider Demographics
NPI:1720347925
Name:EISENTRAUT, KELLY CHRISTINE (MS)
Entity Type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:CHRISTINE
Last Name:EISENTRAUT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 RACE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-4070
Mailing Address - Country:US
Mailing Address - Phone:720-556-1564
Mailing Address - Fax:303-953-7325
Practice Address - Street 1:3350 RACE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-4070
Practice Address - Country:US
Practice Address - Phone:720-556-1564
Practice Address - Fax:303-953-7325
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health