MEDICARE: DARLA J SLICTON PSYD, LPC, PSY

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	101YP2500X	Professional Counselor	4223	CO
2	103TC0700X	Clinical Psychologist	PSY.0004454	CO

General Provider Information

NPI Number	:	1891874616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARLA J SLICTON PSYD, LPC, PSY

Provider Business Mailing Address
First Line	:	4810 SETON PL
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-5205
Country	:	US
Telephone Number	:	719-593-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2864 S CIRCLE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4114
Country	:	US
Telephone Number	:	719-572-6100
Fax Number	:

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

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	09/09/2016

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