MEDICARE: SUNFLOWER PSYCHOLOGICAL SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	3113	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C810702	OTHER	CO	MEDICARE PTAN

General Provider Information

NPI Number	:	1396058020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNFLOWER PSYCHOLOGICAL SERVICES

Provider Business Mailing Address
First Line	:	276 COBBLESTONE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-7625
Country	:	US
Telephone Number	:	719-930-8484
Fax Number	:	719-375-5266

Provider Business Practice Location Address
First Line	:	524 N TEJON ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-4926
Country	:	US
Telephone Number	:	719-930-8484
Fax Number	:	719-375-5266

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEANNE HINKELMAN
Credential	:	PH.D.
Telephone Number	:	719-930-8484

Provider Enumeration Date	:	07/22/2010
Last Update Date	:	07/29/2010

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