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General NPI Number Information
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NPI Number | 1417047770
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Entity Type | Individual
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Provider Name | ALICE M NEWBERRY PH.D.
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Gender | Female
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Dates
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Enumeration Date | 10/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 300 MAIN ST SUITE 312
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-2470
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Country | US
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Telephone | 970-263-4822
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Fax | 970-491-4997
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Provider Business Mailing Address
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Address Line | 521 SKYWAY DR
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City | GRAND JUNCTION
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State | CO
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Zip | 81503-1419
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Country | US
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Telephone | 970-243-7165
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Fax | 970-241-4997
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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 | 2255
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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 | 117425-2501
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License Number State | UT
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