Provider Demographics
NPI:1881921021
Name:STERN, MICHAEL ADAM
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ADAM
Last Name:STERN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 S POTOMAC ST STE 133
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-5442
Mailing Address - Country:US
Mailing Address - Phone:303-755-0810
Mailing Address - Fax:303-755-0796
Practice Address - Street 1:1550 S POTOMAC ST STE 133
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5442
Practice Address - Country:US
Practice Address - Phone:303-755-0810
Practice Address - Fax:303-755-0796
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10930106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist