Healthcare Provider Details

I. General information

NPI: 1790165843
Provider Name (Legal Business Name): LUIS MACIAS-ABBOTT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 HARRISON ST
DENVER CO
80206-1917
US

IV. Provider business mailing address

1528 HARRISON ST
DENVER CO
80206-1917
US

V. Phone/Fax

Practice location:
  • Phone: 408-409-3864
  • Fax:
Mailing address:
  • Phone: 408-409-3864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0003219
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: