Healthcare Provider Details

I. General information

NPI: 1275260770
Provider Name (Legal Business Name): HIDDEN PEAKS PSYCHOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 E PRENTICE AVE PH 1500
GREENWOOD VILLAGE CO
80111-2927
US

IV. Provider business mailing address

PO BOX 1128
GUAYNABO PR
00970-1128
US

V. Phone/Fax

Practice location:
  • Phone: 720-340-8290
  • Fax:
Mailing address:
  • Phone: 720-340-8290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. FABIAN A CONSBRUCK
Title or Position: NEUROPSYCHOLOGIST
Credential: PSY.D.
Phone: 720-340-8290