Healthcare Provider Details

I. General information

NPI: 1114830726
Provider Name (Legal Business Name): THEODORE JOHN USATYNSKI LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8931 HURON ST
THORNTON CO
80260-6806
US

IV. Provider business mailing address

PO BOX 6124
BROOMFIELD CO
80021-0003
US

V. Phone/Fax

Practice location:
  • Phone: 303-853-3616
  • Fax:
Mailing address:
  • Phone: 303-853-3616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0023072
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: