MEDICARE: DR. JAMES LAWRENCE BIXLER 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	103T00000X	Psychologist	088595	IA
2	103T00000X	Psychologist	PSY.0004586	CO

General Provider Information

NPI Number	:	1669963427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES LAWRENCE BIXLER PSY.D.

Provider Business Mailing Address
First Line	:	6180 LEHMAN DR
Second Line	:	STE 100
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3415
Country	:	US
Telephone Number	:	719-452-4803
Fax Number	:

Provider Business Practice Location Address
First Line	:	4003 N WEBER ST STE B2
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-4410
Country	:	US
Telephone Number	:	719-930-7911
Fax Number	:

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

Provider Enumeration Date	:	05/28/2018
Last Update Date	:	12/20/2018

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