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General NPI Number Information
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NPI Number | 1760685853
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Entity Type | Organization
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Legal Business Name | COLORADO NEUROBEHAVIORAL HEALTH INC.
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 1776 S JACKSON ST SUITE 618
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City | DENVER
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State | CO
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Zip | 80210-3801
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Country | US
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Telephone | 720-482-8095
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Fax | 720-529-1557
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Provider Business Mailing Address
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Address Line | 1776 S JACKSON ST SUITE 618
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City | DENVER
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State | CO
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Zip | 80210-3801
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Country | US
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Telephone | 720-482-8095
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Fax | 720-529-1557
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. DIANE M GARD
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Credential | M.D.
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Telephone | 720-482-8095
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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 | 2264
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License Number State | CO
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