Healthcare Provider Details

I. General information

NPI: 1679409627
Provider Name (Legal Business Name): BEACON PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8310 ILEX DR
COLORADO SPRINGS CO
80920-5794
US

IV. Provider business mailing address

8310 ILEX DR
COLORADO SPRINGS CO
80920-5794
US

V. Phone/Fax

Practice location:
  • Phone: 970-629-1569
  • Fax:
Mailing address:
  • Phone: 970-629-1569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. KEITH AARON KUTNAR
Title or Position: MANAGING MEMBER
Credential: PSYD
Phone: 970-629-1569