Healthcare Provider Details

I. General information

NPI: 1841424546
Provider Name (Legal Business Name): BEHAVIORAL SLEEP MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2009
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 KELLY JOHNSON BLVD STE 111
COLORADO SPRINGS CO
80920-3957
US

IV. Provider business mailing address

6895 BATTLE MOUNTAIN RD
COLORADO SPRINGS CO
80922-1242
US

V. Phone/Fax

Practice location:
  • Phone: 719-373-0051
  • Fax:
Mailing address:
  • Phone: 719-373-0051
  • Fax: 719-373-0052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT N GLIDEWELL
Title or Position: MANAGER
Credential: PSYD
Phone: 719-239-7078