Healthcare Provider Details

I. General information

NPI: 1619179025
Provider Name (Legal Business Name): WILLIAM N. COSTAS PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7996 S VINCENNES WAY
CENTENNIAL CO
80112-3333
US

IV. Provider business mailing address

7996 S VINCENNES WAY
CENTENNIAL CO
80112-3333
US

V. Phone/Fax

Practice location:
  • Phone: 303-919-0000
  • Fax:
Mailing address:
  • Phone: 303-919-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1301
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: