Healthcare Provider Details

I. General information

NPI: 1538689195
Provider Name (Legal Business Name): PUEBLO PIONEER PSYCHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 EAGLERIDGE BLVD
PUEBLO CO
81008-2103
US

IV. Provider business mailing address

1124 EAGLERIDGE BLVD
PUEBLO CO
81008-2103
US

V. Phone/Fax

Practice location:
  • Phone: 719-470-0514
  • Fax: 719-960-2444
Mailing address:
  • Phone: 719-470-0514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ARLYN ALZATE
Title or Position: OFFICE MANAGER
Credential:
Phone: 719-470-0540