Individual
ELYSE L SHIRES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9197 W 6TH AVE STE 1000, LAKEWOOD, CO 80215-5109
(303) 233-3122
Mailing address
9197 W 6TH AVE STE 1000, LAKEWOOD, CO 80215-5109
(303) 233-3122
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
RBT-19-96620
CO
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT-19-96620
MEDICAID AND KAISER
CO
Enumeration date
09/25/2019
Last updated
04/18/2024
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