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General NPI Number Information
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NPI Number | 1376974121
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Entity Type | Organization
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Legal Business Name | FRONT RANGE PSYCHIATRY
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Dates
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Enumeration Date | 12/04/2013
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Last Update Date | 12/04/2013
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Provider Practice Location Address
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Address Line | 1707 COLE BLVD SUITE 100
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City | GOLDEN
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State | CO
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Zip | 80401-3220
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Country | US
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Telephone | 303-716-8013
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Fax |
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Provider Business Mailing Address
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Address Line | 538 COMMONS DR
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City | GOLDEN
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State | CO
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Zip | 80401-5705
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | MRS. KERI GOTTLIEB
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Credential |
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Telephone | 303-716-8013
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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 | 46585
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License Number State | CO
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