Healthcare Provider Details

I. General information

NPI: 1639775596
Provider Name (Legal Business Name): PRISMA DIMENSIONS GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2971 SKYWARD WAY
CASTLE ROCK CO
80109-3686
US

IV. Provider business mailing address

480 S VICTOR WAY
AURORA CO
80012-2487
US

V. Phone/Fax

Practice location:
  • Phone: 303-725-3246
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALLISON GUZZO
Title or Position: MEMBER
Credential: M.ED., BCBA
Phone: 303-725-3246