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General NPI Number Information
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NPI Number | 1932366218
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Entity Type | Organization
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Legal Business Name | PSYCHOEDUCATIONAL ASSESSMENT SERVICES, LLC
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 5210 HALF MOON DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80915-1125
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Country | US
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Telephone | 719-205-2800
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Fax | 719-596-5027
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Provider Business Mailing Address
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Address Line | 5210 HALF MOON DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80915-1125
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Country | US
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Telephone | 719-205-2800
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Fax | 719-596-5027
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | BEATRICE DOLORES FLOREZ
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Credential | MSW
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Telephone | 719-205-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 989604
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License Number State | CO
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