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General NPI Number Information
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NPI Number | 1871717520
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Entity Type | Organization
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Legal Business Name | SOUTHEAST PSYCHOTHERAPY ASSOCIATES, PLLC
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6081 S QUEBEC ST STE 103
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City | ENGLEWOOD
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State | CO
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Zip | 80111-4537
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Country | US
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Telephone | 303-694-2782
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Fax |
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Provider Business Mailing Address
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Address Line | 6081 S QUEBEC ST STE 103
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City | ENGLEWOOD
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State | CO
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Zip | 80111-4537
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. MICHELLE DOFT DAWSON
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Credential | PSY.D.
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Telephone | 303-694-2782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 3013
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License Number State | CO
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