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General NPI Number Information
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NPI Number | 1043753734
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Entity Type | Organization
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Legal Business Name | AN INTUITIVE MIND COUNSELING CONSULTING & PSYCHOLOGICAL SERVICE
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Dates
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Enumeration Date | 11/29/2016
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Last Update Date | 04/09/2018
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Provider Practice Location Address
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Address Line | 12835 EAST ARAPAHOE RD TOWER II, SUITE 440
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City | CENTENNIAL
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State | CO
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Zip | 80112-4037
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Country | US
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Telephone | 720-984-0244
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Fax |
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Provider Business Mailing Address
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Address Line | 12835 EAST ARAPAHOE RD TOWER II, SUITE 440
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City | CENTENNIAL
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State | CO
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Zip | 80112-4037
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Country | US
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Telephone | 720-984-0244
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST/OWNER
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Name | BRYCE CRAIG WILLSON
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Credential |
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Telephone | 720-984-0244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 3874
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License Number State | CO
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