MEDICARE: NEURO HOPE PSYCHOTHERAPY & NEUROFEEDBACK PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	12736	CO

General Provider Information

NPI Number	:	1104165240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEURO HOPE PSYCHOTHERAPY & NEUROFEEDBACK PLLC

Provider Business Mailing Address
First Line	:	7730 N UNION BLVD STE 105
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-4075
Country	:	US
Telephone Number	:	719-323-3094
Fax Number	:	719-266-1773

Provider Business Practice Location Address
First Line	:	7680 GODDARD ST STE 130
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-8233
Country	:	US
Telephone Number	:	719-323-3094
Fax Number	:	719-266-1773

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	ZOE BONACK
Credential	:	PSYD
Telephone Number	:	719-323-3094

Provider Enumeration Date	:	02/09/2013
Last Update Date	:	08/27/2024

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