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General NPI Number Information
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NPI Number | 1912464777
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Entity Type | Organization
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Legal Business Name | COLORADO SEMINARY
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Dates
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Enumeration Date | 02/27/2019
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Last Update Date | 02/27/2019
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Provider Practice Location Address
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Address Line | 1999 E. EVANS AVENUE ATTN: ANDI PUSAVAT, KRH RM. 145
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City | DENVER
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State | CO
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Zip | 80208
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Country | US
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Telephone | 303-871-3230
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Fax |
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Provider Business Mailing Address
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Address Line | 1999 E. EVANS AVENUE ATTN: ANDI PUSAVAT, KRH RM. 145
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City | DENVER
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State | CO
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Zip | 80208
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Country | US
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Telephone | 303-871-3230
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | ANDREA PUSAVAT
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Credential | PHD
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Telephone | 303-871-3230
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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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