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General NPI Number Information
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NPI Number | 1073023974
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Entity Type | Organization
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Legal Business Name | COTTONWOOD CREEK WELLNESS CENTER
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Dates
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Enumeration Date | 10/05/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 3210 E. WOODMEN RD. 110
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920
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Country | US
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Telephone | 719-445-6744
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Fax |
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Provider Business Mailing Address
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Address Line | 20219 HIGH PINES DR
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City | MONUMENT
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State | CO
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Zip | 80132-8383
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Country | US
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Telephone | 303-888-1021
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Fax |
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Authorized Official
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Title or Position | CEO/CLINICAL DIRECTOR
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Name | ANGIE DUNN
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Credential | PH.D.
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Telephone | 719-445-6744
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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 | 3567
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License Number State | CO
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