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General NPI Number Information
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NPI Number | 1134195431
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Entity Type | Individual
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Provider Name | AUGUST VANDERBEEK PSY D
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Gender | Female
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Dates
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Enumeration Date | 02/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 75 SOUTH PAGOSA BLVD
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City | PAGOSA SPRINGS
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State | CO
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Zip | 81147
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Country | US
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Telephone | 970-385-3969
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Fax |
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Provider Business Mailing Address
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Address Line | 581 RAINBOW DR
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City | PAGOSA SPRINGS
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State | CO
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Zip | 81147
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Country | US
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Telephone | 970-264-6216
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2354
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 5010
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License Number State | FL
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