MEDICARE: DR. DAVID BONNELL HATFIELD PH.D.

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	103TC0700X	Clinical Psychologist	2559	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2559	OTHER	CO	PSYCHOLOGIST LICENSE

General Provider Information

NPI Number	:	1265435424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID BONNELL HATFIELD PH.D.

Provider Business Mailing Address
First Line	:	1115 ELKTON DR
Second Line	:	STE 300
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-8507
Country	:	US
Telephone Number	:	719-640-8066
Fax Number	:

Provider Business Practice Location Address
First Line	:	1115 ELKTON DR
Second Line	:	SUITE 403
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-8507
Country	:	US
Telephone Number	:	719-574-6562
Fax Number	:	719-570-0386

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	11/27/2013

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