MEDICARE: ALEXIS GANZ PSY.D.

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	103TC0700X	Clinical Psychologist	PSY5268	CO

General Provider Information

NPI Number	:	1427427939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS GANZ PSY.D.

Provider Business Mailing Address
First Line	:	1681 LITTLE OVERLOOK ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-4495
Country	:	US
Telephone Number	:	714-317-3523
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 W 13TH ST
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81003-1975
Country	:	US
Telephone Number	:	719-544-4800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2015
Last Update Date	:	04/06/2026

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