Healthcare Provider Details

I. General information

NPI: 1841322773
Provider Name (Legal Business Name): JONATHAN NABIL SOWEIDY B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 SHERMAN ST
DENVER CO
80216-2061
US

IV. Provider business mailing address

2898 AURORA AVE APT 70
BOULDER CO
80303-2255
US

V. Phone/Fax

Practice location:
  • Phone: 303-293-8554
  • Fax:
Mailing address:
  • Phone: 720-373-7095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: