Healthcare Provider Details

I. General information

NPI: 1922524701
Provider Name (Legal Business Name): ANAHITA LAKE-KHOSRAVI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 QUEBEC ST STE 4300
DENVER CO
80207-2322
US

IV. Provider business mailing address

3401 QUEBEC ST STE 4300
DENVER CO
80207-2322
US

V. Phone/Fax

Practice location:
  • Phone: 720-315-4647
  • Fax:
Mailing address:
  • Phone: 720-315-4647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY.0005846
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY.0005846
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: