Provider Demographics
NPI:1912914458
Name:DENMARK, LAWRENCE M (EDD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:M
Last Name:DENMARK
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 REMINGTON ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524
Mailing Address - Country:US
Mailing Address - Phone:970-218-6778
Mailing Address - Fax:
Practice Address - Street 1:503 REMINGTON ST
Practice Address - Street 2:SUITE 210
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524
Practice Address - Country:US
Practice Address - Phone:970-218-6778
Practice Address - Fax:970-493-5131
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO697103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical