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General NPI Number Information
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NPI Number | 1518606474
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Entity Type | Individual
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Provider Name | SEAN ELIAS THEODORATOS MSW, SWC, LAC
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Gender | Male
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Dates
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Enumeration Date | 05/31/2022
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Last Update Date | 10/26/2024
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Provider Practice Location Address
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Address Line | 4130 TEJON ST STE C
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City | DENVER
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State | CO
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Zip | 80211-1813
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Country | US
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Telephone | 720-957-7964
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Fax |
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Provider Business Mailing Address
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Address Line | 934 CHEROKEE ST
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City | STRASBURG
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State | CO
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Zip | 80136-8046
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Country | US
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Telephone | 720-957-7964
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | SWC.0000001295
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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