Healthcare Provider Details

I. General information

NPI: 1467967000
Provider Name (Legal Business Name): COURTNEY DEYO-BUNDY MA, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1693 QUENTIN ST
AURORA CO
80045-2518
US

IV. Provider business mailing address

8801 LIPAN ST
THORNTON CO
80260-4912
US

V. Phone/Fax

Practice location:
  • Phone: 720-848-3000
  • Fax: 720-848-3015
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPCC.0015598
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number103TC1900X
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0015741
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: