Healthcare Provider Details

I. General information

NPI: 1962486068
Provider Name (Legal Business Name): MICHELLE MARIE TEMPLETON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12021 PENNSYLVANIA ST STE 202
THORNTON CO
80241-3152
US

IV. Provider business mailing address

PO BOX 1224
EASTLAKE CO
80614-1224
US

V. Phone/Fax

Practice location:
  • Phone: 720-425-1111
  • Fax: 303-450-1574
Mailing address:
  • Phone: 720-425-1111
  • Fax: 303-648-4114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2934
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: