Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 0015639 | CO |
NPI | 1003373093 |
---|---|
Provider Name | Trina Renee Bozeman |
First Address | Denver, CO 80205-3428 |
Second Address | Westminster, CO 80030-4909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2019 |
Last Update Date | 08/10/2019 |