# INDIVIDUAL PROVIDER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821479122
- **Authorized official:** ALICIA D LETO M.A. (THERAPIST)
- **Authorized official phone:** (970) 618-6796

## Contact information

- **Practice address:** 4159 LOWELL BLVD, DENVER, CO 80211-1658
- **Practice address phone:** (303) 458-7220
- **Mailing address:** 2800 KALMIA AVE, \#A204, BOULDER, CO 80301-1542
- **Mailing address phone:** (970) 618-6796

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | NLC.0105326 | CO | Yes |

## Other

- **Enumeration date:** 06/11/2015
- **Last updated:** 06/11/2015