Provider Demographics
NPI:1447662739
Name:SOUTHEAST PSYCHIATRIC ASSOCIATES, INC.
Entity type:Organization
Organization Name:SOUTHEAST PSYCHIATRIC ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:720-493-1101
Mailing Address - Street 1:3979 E ARAPAHOE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2072
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19284 COTTONWOOD DR
Practice Address - Street 2:SUITE 202
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-3882
Practice Address - Country:US
Practice Address - Phone:720-493-5467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty