MEDICARE: PSYCHOLOGICAL ASSOCIATES OF THE ROCKIES

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	3152	CO

General Provider Information

NPI Number	:	1548653520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHOLOGICAL ASSOCIATES OF THE ROCKIES

Provider Business Mailing Address
First Line	:	6021 S SYRACUSE WAY STE 201
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-4747
Country	:	US
Telephone Number	:	303-779-0609
Fax Number	:

Provider Business Practice Location Address
First Line	:	6021 S SYRACUSE WAY STE 201
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-4747
Country	:	US
Telephone Number	:	303-779-0609
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JANE CLEVELAND
Credential	:	PSY.D.
Telephone Number	:	303-779-0609

Provider Enumeration Date	:	03/14/2015
Last Update Date	:	03/14/2015

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