Healthcare Provider Details

I. General information

NPI: 1891148458
Provider Name (Legal Business Name): DANDELION PSYCHOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7850 VANCE DR STE 185
ARVADA CO
80003-2127
US

IV. Provider business mailing address

9930 W 105TH AVE
WESTMINSTER CO
80021-7324
US

V. Phone/Fax

Practice location:
  • Phone: 303-704-3612
  • Fax: 512-597-2829
Mailing address:
  • Phone: 303-704-3612
  • Fax: 512-597-2829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4004
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number4004
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number4004
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09923708
License Number StateCO

VIII. Authorized Official

Name: DR. BETH RENAE PETERS
Title or Position: FOUNDER AND PSYCHOLOGIST
Credential: PHD
Phone: 303-704-3612