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General NPI Number Information
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NPI Number | 1962045682
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Entity Type | Individual
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Provider Name | ALEX THEOBALD LMFT
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Gender | Male
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Dates
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Enumeration Date | 10/25/2019
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 2121 S ONEIDA ST STE 600
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City | DENVER
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State | CO
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Zip | 80224-2555
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Country | US
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Telephone | 720-863-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 2121 S ONEIDA ST STE 600
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City | DENVER
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State | CO
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Zip | 80224-2555
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Country | US
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Telephone | 720-863-6100
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT.0002620
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License Number State |
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