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General NPI Number Information
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NPI Number | 1699373621
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Entity Type | Organization
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Legal Business Name | COLORADO SPRINGS PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 10/12/2020
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Last Update Date | 11/03/2020
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Provider Practice Location Address
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Address Line | 6000 E EVANS AVE STE 350
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City | DENVER
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State | CO
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Zip | 80222-5406
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Country | US
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Telephone | 719-357-6471
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Fax |
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Provider Business Mailing Address
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Address Line | 1115 ELKTON DR STE 301
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-3597
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Country | US
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Telephone | 719-357-6471
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | RYAN L COLE
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Credential | PSY.D
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Telephone | 719-357-6471
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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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