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General NPI Number Information
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NPI Number | 1275260770
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Entity Type | Organization
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Legal Business Name | HIDDEN PEAKS PSYCHOLOGY, PLLC
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Dates
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Enumeration Date | 08/04/2022
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Last Update Date | 08/04/2022
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Provider Practice Location Address
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Address Line | 3855 AMBROSIA ST STE 302
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City | CASTLE ROCK
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State | CO
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Zip | 80109-3959
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Country | US
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Telephone | 720-340-8290
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Fax |
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Provider Business Mailing Address
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Address Line | 3855 AMBROSIA ST STE 302
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City | CASTLE ROCK
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State | CO
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Zip | 80109-3959
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Country | US
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Telephone | 720-340-8290
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Fax |
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Authorized Official
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Title or Position | NEUROPSYCHOLOGIST
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Name | DR. FABIAN A CONSBRUCK
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Credential | PSY.D.
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Telephone | 720-340-8290
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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