Healthcare Provider Details

I. General information

NPI: 1316368996
Provider Name (Legal Business Name): PROFESSIONAL PSYCHOLOGY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2013
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E 58TH AVE STE 210
DENVER CO
80216-1400
US

IV. Provider business mailing address

420 E 58TH AVE STE 210
DENVER CO
80216-1400
US

V. Phone/Fax

Practice location:
  • Phone: 720-854-0262
  • Fax: 720-854-0263
Mailing address:
  • Phone: 720-854-0262
  • Fax: 720-854-0263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number2519
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMIE QUINN HIDALGO
Title or Position: OWNER
Credential: MA, LPC
Phone: 720-937-9758