Provider Demographics
NPI:1023630845
Name:NAVARRETE, LYA MICHELLE
Entity type:Individual
Prefix:
First Name:LYA
Middle Name:MICHELLE
Last Name:NAVARRETE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8125 LINDERMAN RD
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-7930
Mailing Address - Country:US
Mailing Address - Phone:719-960-6605
Mailing Address - Fax:
Practice Address - Street 1:4760 FLINTRIDGE DR STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4266
Practice Address - Country:US
Practice Address - Phone:719-465-3695
Practice Address - Fax:719-465-3914
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-20-117996106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician