Healthcare Provider Details

I. General information

NPI: 1033509476
Provider Name (Legal Business Name): ALBERT LEROY PACE IV PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 W HAMPDEN AVE STE 415
ENGLEWOOD CO
80110-2151
US

IV. Provider business mailing address

1777 S BELLAIRE ST STE 390
DENVER CO
80222-4350
US

V. Phone/Fax

Practice location:
  • Phone: 720-377-1359
  • Fax:
Mailing address:
  • Phone: 720-515-4244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0005129
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: