Healthcare Provider Details

I. General information

NPI: 1164738654
Provider Name (Legal Business Name): CENTER FOR DEVELOPMENTAL & BEHAVIORAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2010
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 PALMER AVE
BENNETT CO
80102-7837
US

IV. Provider business mailing address

475 PALMER AVE
BENNETT CO
80102-7837
US

V. Phone/Fax

Practice location:
  • Phone: 303-349-7857
  • Fax:
Mailing address:
  • Phone: 303-644-3353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number4913
License Number StateCO

VIII. Authorized Official

Name: MS. CYNTHIA K. BUSETTI
Title or Position: CLINICAL DIRECTOR
Credential: LPC
Phone: 303-349-7857