Healthcare Provider Details

I. General information

NPI: 1710083969
Provider Name (Legal Business Name): DR. MICHELLE C WINSTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6375 EAGLE COURT
NIWOT CO
80503-8331
US

IV. Provider business mailing address

PO BOX 21405
BOULDER CO
80308-4405
US

V. Phone/Fax

Practice location:
  • Phone: 303-444-1655
  • Fax: 303-444-8781
Mailing address:
  • Phone: 303-444-1655
  • Fax: 303-444-8781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1314
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1314
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1314
License Number StateCO

VIII. Authorized Official

Name: DR. MICHELLE C WINSTON
Title or Position: PRESIDENT
Credential: PSY.D.
Phone: 303-444-1655