Healthcare Provider Details

I. General information

NPI: 1609646835
Provider Name (Legal Business Name): ALPHA NEURO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2918 BEACON ST
COLORADO SPRINGS CO
80907-9208
US

IV. Provider business mailing address

2918 BEACON ST
COLORADO SPRINGS CO
80907-9208
US

V. Phone/Fax

Practice location:
  • Phone: 214-701-0158
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSICA K ALLEN
Title or Position: OWNER
Credential: PH.D., LP, BCBA
Phone: 214-701-0158