Healthcare Provider Details

I. General information

NPI: 1629641006
Provider Name (Legal Business Name): EMILY TAYLOR DURHAM PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMMA DURHAM PSYD

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 S BELLAIRE ST STE 390
DENVER CO
80222-4350
US

IV. Provider business mailing address

1777 S BELLAIRE ST STE 390
DENVER CO
80222-4350
US

V. Phone/Fax

Practice location:
  • Phone: 720-515-4244
  • Fax:
Mailing address:
  • Phone: 720-515-4244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY.0006247
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: