Individual
ASEAL MARK MANSOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13613 WINDOM LN, BROOMFIELD, CO 80023-4069
(720) 498-7969
Mailing address
13613 WINDOM LN, BROOMFIELD, CO 80023-4069
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q373811
—
CO
Enumeration date
08/31/2022
Last updated
08/31/2022
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