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General NPI Number Information
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NPI Number | 1851684013
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Entity Type | Organization
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Legal Business Name | NEUROPSYCHOLOGICAL CONSULTS OF NORTHERN COLORADO LLC
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Dates
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Enumeration Date | 05/20/2011
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Last Update Date | 10/10/2014
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Provider Practice Location Address
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Address Line | 155 BOARDWALK DR SUITE 418
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City | FORT COLLINS
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State | CO
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Zip | 80525-3040
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Country | US
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Telephone | 970-631-7133
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7219
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City | GILLETTE
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State | WY
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Zip | 82717-7219
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Country | US
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Telephone | 970-631-7133
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BARBARA LYNNE ST CLAIR
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Credential | PSYD
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Telephone | 970-631-7133
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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 |
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License Number State |
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