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General NPI Number Information
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NPI Number | 1013147636
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Entity Type | Organization
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Legal Business Name | DEB ELLIOTT-DESORBO, PH.D., LLC
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Dates
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Enumeration Date | 07/16/2009
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Last Update Date | 07/16/2009
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Provider Practice Location Address
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Address Line | 6455 N UNION BLVD SUITE 103
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-5852
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Country | US
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Telephone | 719-332-5177
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 62342
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City | COLORADO SPRINGS
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State | CO
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Zip | 80962-2342
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Country | US
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Telephone | 719-332-5177
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DEBORAH ELLIOTT-DESORBO
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Credential | PH.D.
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Telephone | 719-332-5177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY-3210
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License Number State | CO
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