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General NPI Number Information
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NPI Number | 1366802308
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Entity Type | Organization
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Legal Business Name | COLORADO NEUROPSYCHOLOGY SERVICES LLC
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Dates
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Enumeration Date | 03/03/2016
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Last Update Date | 03/16/2016
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Provider Practice Location Address
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Address Line | 255 CANYON BLVD STE. 200
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City | BOULDER
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State | CO
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Zip | 80302-4979
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Country | US
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Telephone | 303-474-4055
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Fax | 720-638-3699
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Provider Business Mailing Address
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Address Line | 255 CANYON BLVD STE. 200
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City | BOULDER
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State | CO
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Zip | 80302-4979
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Country | US
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Telephone | 303-474-4055
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Fax | 720-638-3699
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST - OWNER
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Name | DR. ELISE GINSBURG STEVENS
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Credential | PH. D.
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Telephone | 303-474-4055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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