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NPI Code Detail

MEDICARE: PROFESSIONAL PSYCHOLOGY ASSOCIATES, PC

MEDICARE: PROFESSIONAL PSYCHOLOGY ASSOCIATES, PC
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
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)2519CO

General Provider Information

NPI Number : 1316368996
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROFESSIONAL PSYCHOLOGY ASSOCIATES, PC
Provider Business Mailing Address
First Line : 420 E 58TH AVE STE 210
Second Line :
City : DENVER
State : CO
Zip : 80216-1400
Country : US
Telephone Number : 720-854-0262
Fax Number : 720-854-0263
Provider Business Practice Location Address
First Line : 420 E 58TH AVE STE 210
Second Line :
City : DENVER
State : CO
Zip : 80216-1400
Country : US
Telephone Number : 720-854-0262
Fax Number : 720-854-0263
Authorized Official
Title or Position : OWNER
Name : JAMIE QUINN HIDALGO
Credential : MA, LPC
Telephone Number : 720-937-9758
Provider Enumeration Date : 12/26/2013
Last Update Date : 08/27/2024

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