Healthcare Provider Details

I. General information

NPI: 1114349032
Provider Name (Legal Business Name): TIMOTHY A PASTERNAK B.F.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2014
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2185 THISTLE RIDGE CIR
HIGHLANDS RANCH CO
80126-2633
US

IV. Provider business mailing address

2185 THISTLE RIDGE CIR
HIGHLANDS RANCH CO
80126-2633
US

V. Phone/Fax

Practice location:
  • Phone: 303-871-3626
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPSY.0005178
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: