Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | LPC #257 | CO |
NPI | 1043629660 |
---|---|
Provider Name | Dr. Leslie Dwyer |
First Address | Fort Collins, CO 80521-2864 |
Second Address | Fort Collins, CO 80521-2864 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2014 |
Last Update Date | 07/08/2014 |