Healthcare Provider Details

I. General information

NPI: 1174017891
Provider Name (Legal Business Name): GAMEPLAN THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2443 S UNIVERSITY BLVD STE 115
DENVER CO
80210-5407
US

IV. Provider business mailing address

2443 S UNIVERSITY BLVD STE 115
DENVER CO
80210-5407
US

V. Phone/Fax

Practice location:
  • Phone: 303-747-5855
  • Fax:
Mailing address:
  • Phone: 303-747-5855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY.0004811
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY24600
License Number StateCA

VIII. Authorized Official

Name: DR. SARAH ANN HAIDER
Title or Position: EXECUTIVE DIRECTOR/PSYCHOLOGIST
Credential: PSY.D.
Phone: 303-747-5855