MEDICARE: RYAN DARRYL ESPINOZA LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0011972	CO

General Provider Information

NPI Number	:	1770008187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN DARRYL ESPINOZA LPC

Provider Business Mailing Address
First Line	:	10190 W BERRY DR
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80127-1856
Country	:	US
Telephone Number	:	303-956-9805
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 S WADSWORTH BLVD
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-3414
Country	:	US
Telephone Number	:	720-989-1905
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2017
Last Update Date	:	08/07/2017

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