Healthcare Provider Details

I. General information

NPI: 1700819497
Provider Name (Legal Business Name): COLORADO NEUROPSYCHOLOGICAL & BEHAVIORAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8751 E HAMPDEN AVE STE C2
DENVER CO
80231-4930
US

IV. Provider business mailing address

8751 E HAMPDEN AVE STE C2
DENVER CO
80231-4930
US

V. Phone/Fax

Practice location:
  • Phone: 720-468-3651
  • Fax: 720-468-3651
Mailing address:
  • Phone: 720-468-3651
  • Fax: 303-745-3489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number2506
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2506
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2539
License Number StateCO

VIII. Authorized Official

Name: DR. BRADLEY F. MCMILLAN
Title or Position: PARTNER
Credential: PH.D.
Phone: 720-468-3651