Healthcare Provider Details

I. General information

NPI: 1699211722
Provider Name (Legal Business Name): BERYIMAR H PEROZO TREJO CAS NLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 CHEROKEE ST
DENVER CO
80204
US

IV. Provider business mailing address

4901 LELAND PT
COLORADO SPRINGS CO
80916-1637
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-3500
  • Fax:
Mailing address:
  • Phone: 720-933-5161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACC.0020891
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: