Healthcare Provider Details

I. General information

NPI: 1699969899
Provider Name (Legal Business Name): STACEY CAROL DIRZUWEIT MA, LMFT, ATR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12157 W CEDAR DR STE 203
LAKEWOOD CO
80228-2100
US

IV. Provider business mailing address

12157 W CEDAR DR STE 203
LAKEWOOD CO
80228-2100
US

V. Phone/Fax

Practice location:
  • Phone: 720-526-3132
  • Fax: 303-985-7882
Mailing address:
  • Phone: 720-526-3132
  • Fax: 303-985-7882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number09-027
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT.0001397
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: