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General NPI Number Information
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NPI Number | 1285190751
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Entity Type | Organization
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Legal Business Name | ADVANCED TRAUMA RECOVERY LLC
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Dates
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Enumeration Date | 02/20/2019
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Last Update Date | 02/20/2019
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Provider Practice Location Address
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Address Line | 755 MALETA LN STE 202
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City | CASTLE ROCK
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State | CO
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Zip | 80108-7611
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Country | US
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Telephone | 949-233-5358
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Fax |
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Provider Business Mailing Address
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Address Line | 755 MALETA LN STE 202
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City | CASTLE ROCK
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State | CO
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Zip | 80108-7611
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Country | US
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Telephone | 949-233-5358
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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 | MERCEDES LAVOY
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Credential |
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Telephone | 949-233-5358
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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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