Provider Demographics
NPI:1174551089
Name:ARELLANO, CHARLEANEA M (PHD)
Entity type:Individual
Prefix:
First Name:CHARLEANEA
Middle Name:M
Last Name:ARELLANO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15321 HERITAGE CIR
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-9214
Mailing Address - Country:US
Mailing Address - Phone:720-933-0318
Mailing Address - Fax:303-254-9708
Practice Address - Street 1:15321 HERITAGE CIR
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80602-9214
Practice Address - Country:US
Practice Address - Phone:720-933-0318
Practice Address - Fax:303-254-9708
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1902103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07019029Medicaid