Provider Demographics
NPI:1912267246
Name:HETTLEMAN, DANIEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:HETTLEMAN
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 1:1115 GRANT ST
Mailing Address - Street 2:#204
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-2369
Mailing Address - Country:US
Mailing Address - Phone:303-912-6632
Mailing Address - Fax:
Practice Address - Street 1:1115 GRANT ST
Practice Address - Street 2:#204
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-2369
Practice Address - Country:US
Practice Address - Phone:303-912-6632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2399103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent