Provider Demographics
NPI:1720696370
Name:DOPPELT, FAITH WATSON
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:WATSON
Last Name:DOPPELT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FAITH
Other - Middle Name:
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:560 MOHAWK DR APT 36
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-3791
Mailing Address - Country:US
Mailing Address - Phone:864-607-1916
Mailing Address - Fax:
Practice Address - Street 1:5485 CONESTOGA CT STE 110D
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2752
Practice Address - Country:US
Practice Address - Phone:720-295-3825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16328101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional