Healthcare Provider Details

I. General information

NPI: 1093477234
Provider Name (Legal Business Name): SHANA DELWICHE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 E 12TH AVE
DENVER CO
80220-2415
US

IV. Provider business mailing address

4455 E 12TH AVE
DENVER CO
80220-2415
US

V. Phone/Fax

Practice location:
  • Phone: 303-912-0692
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0023246
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: