Healthcare Provider Details

I. General information

NPI: 1912174459
Provider Name (Legal Business Name): COLORADO CENTER FOR BIOBEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 KALMIA AVE
BOULDER CO
80304-1810
US

IV. Provider business mailing address

1229 KALMIA AVE.
BOULDER CO
80304-1310
US

V. Phone/Fax

Practice location:
  • Phone: 303-449-8815
  • Fax: 720-524-6965
Mailing address:
  • Phone: 303-449-8815
  • Fax: 720-524-6965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number322
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number16419
License Number StateCO

VIII. Authorized Official

Name: MS. CAROL J SCHNEIDER
Title or Position: DIRECTOR
Credential: PHD
Phone: 303-449-2364