Healthcare Provider Details

I. General information

NPI: 1891767950
Provider Name (Legal Business Name): FRANK JOSEPH GODSHALL PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 COCHRANE CIRCLE EBHS-3, DBH, EACH
FORT CARSON CO
80913
US

IV. Provider business mailing address

7500 COCHRANE CIRCLE EBHS-3, DBH, EACH
FORT CARSON CO
80913
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-0175
  • Fax:
Mailing address:
  • Phone: 719-526-0175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY2940
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number253
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: