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Individual

B SIMONE CARUTHERS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PHD

Contact information

Practice address
1625 SIMMS ST, LAKEWOOD, CO 80215-2611
(303) 238-8161
Mailing address
4860 ROBB ST STE 201, WHEAT RIDGE, CO 80033-2162
(303) 278-7418
(888) 341-5050

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY.0002149
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
11581204
CAQH
CO
01
C472348
MEDICARE GRP PTAN
CO
01
PSY.0002149
PROFESSIONAL LICENSE
CO
Enumeration date
08/12/2014
Last updated
08/12/2014
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