Provider Demographics
NPI:1952146359
Name:PROANO, IAN RICHARD (MA)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:RICHARD
Last Name:PROANO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5936 E 129TH PL
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-7889
Mailing Address - Country:US
Mailing Address - Phone:303-704-8184
Mailing Address - Fax:
Practice Address - Street 1:12021 PENNSYLVANIA ST STE 108
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-3151
Practice Address - Country:US
Practice Address - Phone:720-881-6454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0021503101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional