Provider Demographics
NPI:1912338419
Name:UNIVERSITY OF DENVER PROFESSIONAL PSYCHOLOGY CLININ
Entity Type:Organization
Organization Name:UNIVERSITY OF DENVER PROFESSIONAL PSYCHOLOGY CLININ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FERNAND
Authorized Official - Middle Name:
Authorized Official - Last Name:LUGUBUIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:303-871-3988
Mailing Address - Street 1:2450 S. VINE ST.
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2450 S VINE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5264
Practice Address - Country:US
Practice Address - Phone:303-871-3988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health