Healthcare Provider Details

I. General information

NPI: 1548744220
Provider Name (Legal Business Name): YEN-PO LAI MT-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 S FRASER ST UNIT 2
AURORA CO
80014-4515
US

IV. Provider business mailing address

2222 S FRASER ST UNIT 2
AURORA CO
80014-4515
US

V. Phone/Fax

Practice location:
  • Phone: 303-819-3422
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number14076
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: