MEDICARE: HENRY DOOLEY PSYCHOLOGICAL SERVICES LLC

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	261QM0850X	Adult Mental Health Clinic/Center	PSY.0003965	CO

General Provider Information

NPI Number	:	1114406279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENRY DOOLEY PSYCHOLOGICAL SERVICES LLC

Provider Business Mailing Address
First Line	:	1780 S BELLAIRE ST STE 407
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-4323
Country	:	US
Telephone Number	:	720-441-3690
Fax Number	:

Provider Business Practice Location Address
First Line	:	1780 S BELLAIRE ST STE 407
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-4323
Country	:	US
Telephone Number	:	720-441-3690
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST AND PRESIDENT
Name	:	HENRY DOOLEY
Credential	:
Telephone Number	:	720-441-3690

Provider Enumeration Date	:	08/09/2018
Last Update Date	:	08/09/2018

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