Healthcare Provider Details

I. General information

NPI: 1356887673
Provider Name (Legal Business Name): ANNA GABRIELA LEON BUTRON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11059 E BETHANY DR
AURORA CO
80014-2622
US

IV. Provider business mailing address

1290 CHAMBERS RD
AURORA CO
80011-7117
US

V. Phone/Fax

Practice location:
  • Phone: 303-617-2300
  • Fax:
Mailing address:
  • Phone: 303-617-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0015961
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: