Provider Demographics
NPI:1265616502
Name:LAURENCE S. AYLESWORTH, PH.D. & ASSOCIATES, INC.
Entity type:Organization
Organization Name:LAURENCE S. AYLESWORTH, PH.D. & ASSOCIATES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:AYLESWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:303-839-9773
Mailing Address - Street 1:1300 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-4421
Mailing Address - Country:US
Mailing Address - Phone:303-839-9773
Mailing Address - Fax:303-861-2558
Practice Address - Street 1:1300 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-4421
Practice Address - Country:US
Practice Address - Phone:303-839-9773
Practice Address - Fax:303-861-2558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO939103TC0700X
CO261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC804905Medicare PIN