Healthcare Provider Details

I. General information

NPI: 1912231374
Provider Name (Legal Business Name): COLORADO CLINICAL AND FORENSIC PSYCHOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1884 GAYLORD ST
DENVER CO
80206-1211
US

IV. Provider business mailing address

1884 GAYLORD ST
DENVER CO
80206-1211
US

V. Phone/Fax

Practice location:
  • Phone: 860-810-5817
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number3313
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3313
License Number StateCO

VIII. Authorized Official

Name: DR. NICOLE S KITEI
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 860-810-5817